Objective: The present work was led by a multidisciplinary panel of experts and proposes an extensive review on the use of prescription crystalline glucosamine sulfate (pCGS) in the multimodal treatment of osteoarthritis (OA) applicable in Ukraine and other Commonwealth of Independent States (CIS) countries. Methods: A panel of rheumatologists, orthopedic surgeons, and field experts from Ukraine and CIS regions discussed the management of OA. Literature was systematically searched using Medline, EMBASE, CIHNAL, and Cochrane Library databases. The 2-day meeting critically reviewed the available literature, treatment algorithms, pharmacoeconomic aspects, and real-world instances to form a multimodal approach based both on real-life clinical practice and systematic literature research for the management of OA in Ukraine and CIS countries. Expert Opinion: pCGS plays a pivotal role in the stepwise approach to OA treatment. If it is necessary (step 1), the combined use of pCGS with paracetamol and topical nonsteroidal anti-inflammatory drugs (NSAIDs) has been recommended. If symptoms persist, oral NSAIDs and intra-articular (IA) hyaluronic acid or corticosteroids are added to the therapy (step 2) of pCGS in the patients. In case of insufficient relief and severe OA (step 3), pCGS along with oral NSAIDs, IA corticosteroids, and duloxetine have been recommended. Patient stratification with regular monitoring and careful alterations in treatment were advocated. Conclusions: This expert opinion article recommends a modified approach to the existing guidelines incorporating pCGS in treatment modality of OA in Ukraine and CIS countries. Extensive use of pCGS targets early symptomatic relief in OA while limiting the adverse effects due to long-term use of analgesics and NSAIDs.

Aim. Determination of the concentration of interleukin-10 (IL-10) and interleukin-6 (IL-6) in serum of patients with periodic disease (PD) before and after treatment with colchicin, as well as the identification of correlation between the indicators of these parameters. Materials and methods. We examined 188 patients with PD (89 men, 99 women) aged from 12 to 69 years, as well as 44 patients with rheumatoid arthritis (RA) as a comparison group and 41 healthy people of the control group. Patients were divided into groups: 1 - PD colchicinotherapy patients with seizures without amyloidosis that do not respond to treatment maximum dose of colchicine 2.0 mg/day; 2nd-PD patients without amyloidosis, not responding to treatment 1.5 mg/day colchicine; 3rd - PD patients that responds to certain doses of colchicine (0.5 to 2.0 mg/day); 4th - PD patients without amyloidosis who did not receive treatment; 5-I of the healthy persons of the control group; 6-I - RA patients. The concentration of IL-10 in blood serum was determined by enzyme immunoassay ELISA, and IL-6 - immunochemiluminescent method. For statistical processing the computer program SPSS is used. The results were considered statistically significant at the level of reliability p

Ankylosing spondylitis (AS) is the most frequent type of seronegative spondyloarthropathy, which mainly involves the axial spine. In advanced cases, the chronic inflammatory process can cause fibrosis and calcification, which leads to loss of flexibility and fusion of the vertebrae, resembling a "bamboo", with a fixed posture, generally known as chin-on-chest deformation. The functional limitations of this particular deformity are significant: the patients are unable to look forward, make visual contact, and have difficulty eating. All these factors with typically concomitant osteoporosis will significantly increase the risk of spinal injury with severe instability, deformity, and, most importantly, deteriorating neurological function or paralysis requiring spinal surgery. Common indications for spinal intervention on patients with AS are:

Background:Glucocorticosteroids (GCS) are widely used in the treatment of rheumatoid arthritis (RA) as bridge-therapy. Though, according to last recommendations for the treatment of RAGCS should be considered in short-term and different dose regimens and routes of administration and should be tapered as rapidly as clinically feasible. But in some cases, patients received GCS for a long period in low doses(<7.5 mg/day prednisone equivalent).It is well known, thatlong-term GCS use is associated with osteoporosis and increased risk of fracture, even at low daily doses. On the other hand, RA itself leads to the changes in the biomechanical properties of bones through the increased production of pro-inflammatory cytokines. Furthermore, immobilization due to pain from inflamed joints and impairment of physical activity are in response for osteoporosis formation. In addition, patients with RA are often co-prescribed a proton pump inhibitor, which have a reported effect on occurrence of osteoporosis. Taking into consideration all mentioned above patients with RA, receiving GCS therapy reveal high risk for osteoporosis and fracture formation and require corresponding treatment.Objectives:The aim of this study is to evaluate the effect of 12 months treatment with denosumab (bone-modifying agent) in patients with RA, continuing to receive GCS.Methods:50 female patients with RA (mean age 54 ± 6.3 years) were enrolled in this study. Duration of RA was 10.5 ± 3.2 years. All patients received prednisone 15,3± 10,25 mg/day with gradually escalation of dose for ≥ 12 months. As DMARD therapy patients received methotrexate dose in average 15-20mg/week (75%), leflunomide 20 mg/day (25%). Bone mineral density (BMD) is measured in all patients by Dual-energy X-ray absorptiometry (DEXA) at baseline and 12 months after treatment with denosumab. All patients received denosumab 60 mg subcutaneously once every 6 months.Results:The measurement of BMD at baseline revealed the following results: T-score in lumbar spine was -1,95 ± 1,36 and in total hip -1,64± 0,94 with high major osteoporotic fracture risk. All patients completed the study. The BMD after 12 months significantly increased both in lumbar spine +4,2 % (p<0,001) and in total hip +2,1% (p<0,001).Conclusion:Denosumab should be considered as a drug of choice in RA patients, continuing to receive GCS. Further large investigations are needed to assess the BMD after discontinuation of denosumab and evaluate fracture risk in this population of patient.References:[1]J.Compston. Glucocorticoid-induced osteoporosis: an update. Endocrine. 2018; 61(1): 7–16. doi: 10.1007/s12020-018-1588-2[2]A.Giovanni, S.Kenneth. Glucocorticoid-induced osteoporosis update. Current Opinion in Rheumatology: 2019;31(4): 388-393. doi: 10.1097/BOR.0000000000000608Disclosure of Interests:None declared

An otherwise healthy young man was referred to the rheumatologist because of bilateral proximal interphalangeal (PIP) joint enlargements. The main concern was excluding the presence of inflammatory arthritis. Physical examination revealed bilateral PIP finger joints (II-IV) swellings and cutaneous thickenings in adjacent areas. The specificity of this case was the patient who appeared in the physician’s room with his violin suitcase pointing to his profession even from the first site. Complete blood count with leucocyte differentials appeared without changes. Radiographics failed to show joint fluid or bony changes. All immunological markers (RF, anti-cyclic citrullinated peptide) and laboratory data (Erythrocyte sedimentation rate, C-reactive protein, etc) were within the reference ranges or negative. After exclusion of rheumatoid and other inflammatory arthritis, and considering the occupation of the patient and demographics the diagnosis of a rare condition–pachydermodactyly was made.