Стратегия лечения системной красной волчанки «до достижения цели» (Treat-to-Target SLE). Pекомендации международной рабочей группы и комментарии российских экспертов Соловьев С.К., Асеева Е.А., Попкова Т.В., Клюквина Н.Г., Решетняк Т.М., Лисицына Т.А., Кошелева Н.М., Цанян М.Э., Меснянкина А.А., Панафидина Т.А., Кондратьева Л.В., Середавкина Н.В., Герасимова E.В.Начало нового тысячелетия ознаменовано существенным прогрессом в развитии ревматологии: более глубо-ко изучен патогенез многих ревматических заболеваний (РЗ), валидированы критерии диагностики, разра-ботаны индексы активности, внедрены понятия ремиссии и обострения, большое внимание стало уделяться изучению качества жизни пациентов. Существенно расширена возможность фармакотерапии иммуновоспа-лительных РЗ за счет появления генно-инженерных биологических препаратов (ГИБП). Изменилась и стра-тегия терапии пациентов с РЗ. В 2010 г. выдвигается концепция «Лечение до достижения цели» (Treat to Target) для ревматоидного артрита, а позднее для анкилозирующего спондилита. В январе 2013 г. по инициа-тиве ведущих мировых ревматологов стартовал проект создания концепции «Лечение до достижения цели» для системной красной волчанки (СКВ). Результатом их работы стали опубликованные в 2014 г. рекоменда-ции «Лечение СКВ до достижения цели», сформулированные в виде 4 основополагающих принципов и 11 основных рекомендаций. Цель данной публикации -общая характеристика основных положений принципов и рекомендаций с комментариями ведущих специалистов-люпологов с учетом особенностей СКВ в Российской Федерации и обсуждением некоторых дискуссионных и нерешенных проблем. Ключевые слова: системная красная волчанка; «Лечение до достижения цели»; мониторинг. Для ссылки: Соловьев СК, Асеева ЕА, Попкова ТВ и др. Стратегия лечения системной красной волчанки «до достижения цели» (Treat-to-Target SLE). Pекомендации международной рабочей группы и комментарии рос-сийских экспертов. Научно-практическая ревматология. 2015;53(1):9-16. The start of the new millennium is marked by a substantial progress in the development of rheumatology: pathogenesis of many rheumatic diseases (RDs) was more deeply studied; their diagnostic criteria validated; disease activity indices worked out; the concepts of remission and exacerbation introduced; much attention has been given to the investigations of quality of life in patients. The possibility of pharmacotherapy for immunoinflammatory RDs was extended by the advent of biological agents (BA). The treatment strategy for RDs was also changed. The treat-to-target concept was put forth for rheumatoid arthritis in 2010 and for ankylosing spondylitis later. The project of treat-to-target concept in systemic lupus erythematous (SLE) was launched on the initiative of the world's leading rheumatologists in January 2013. The result of their work is the treat-to-target-in-SLE recommendations published in 2014 and formulated as 4 basic principles and 11 general recommendations. The purpose of this publication is to provide general characteristics of the basic provisions...

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BackgroundOur aim was to compare serum levels of cytokines in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).ObjectivesComparative data on cytokine profile in SLE and rheumatoid arthritis RA patients are scarce.MethodsWe examined serum samples from 80 pts with SLE, median and interquartile range (25th–75th percentile) of disease duration 48 (2–432) months; age 31,5 (16–65) years; 72 female; 74 pts with RA, disease duration 90,0 (30,00–192,0) months; age 54,0 (44,0–62,0) years; 59 female, and 28 healthy donors. Cytokine analyses were performed with Bio-Plex® technology (Human Grp I Cytokine 27-plex panel).ResultsPts with SLE had significantly lower levels of IL-1β, -1ra, -2, -9, eotaxin, G-CSF, IFN-γ, MIP-1β, TNF-α, VEGF and higher levels of IL-4, -6, -8, -12, GM-CSF, MCP-1, PDGF-BB, RANTES than healthy donors. Compared to RA, cytokine/chemokine levels from SLE were significantly different. The concentrations of IL-1β, -1ra, -2, -5, -6, -7, -9, -10, -13, 15, eotaxin, FGF, G-CSF, IFN-γ, IP-10, MIP-1α, TNF-α, VEGF in SLE were significantly lower than RA. The concentrations of IL-4, -8, MCP-1, MIP-1β, PDGF-BB, RANTES was higher in the SLE cohort (Table 1).ConclusionsSerum concentration of most proinflammatory, Th-2 related, bone marrow–derived cytokines, stromal cells and angiogenic factors in SLE pts is substantially lower than in healthy donors and pts witch RA. These data demonstrate significantly higher chemokine levels in SLE versus RA.ReferencesChun HY, Chung JW, Kim HA, Yun JM, Jeon JY, Ye YM, Kim SH, Park HS, Suh CH. Cytokine IL-6 and IL-10 as biomarkers in systemic lupus erythematosus. J Clin Immunol. 2007; 27(5):461–6.Kokkonen H, Söderström I, Rocklöv J, Hallmans G, Lejon K, Rantapää Dahlqvist S. Up-regulation of cytokines and chemokines predates the onset of rheumatoid arthritis. Arthritis Rheum. 2010; 62(2):383–91. doi: 10.1002/art.27186.Sieber J, Daridon C, Fleischer SJ, Fleischer V, Hiepe F, Alexander T, Heine G, Burmester GR, Fillatreau S, Dörner T. Active systemic lupus erythematosus is associated with a reduced cytokine production by B cells in response to TLR9 stimulation. Arthritis Res Ther. 2014;16(6):477. doi: 10.1186/s13075-014-0477-1.Disclosure of InterestNone declared

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Objective: to study the frequency of hyperleptinemia in patients with systemic lupus erythematosus (SLE), its relationship with clinical and laboratory manifestations of the disease, drug therapy, and other metabolic disorders.Patients and methods. The cross-sectional study included 46 women with a definite diagnosis of SLE (median age 40 [31; 48] years) and disease duration 3.0 [0.9; 9.0] years. Glucocorticoids (GC) were received by 38 (83%) patients, hydroxychloroquine – by 35 (76%), immunosuppressants – by 10 (22%), biologic disease-modifying antirheumatic drugs – by 5 (11%). In all patients, fasting levels of glucose, leptin, apoliproprotein B (ApoB) and immunoreactive insulin were determined, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. Concentration of leptin ≥11.1 ng/ml, ApoB – >1.6 mg/ml were considered an elevated level. HOMA-IR index ≥2.77 corresponded to the presence of insulin resistance (IR).Results and discussion. Hyperleptinemia was found in 34 (74%) patients with SLE, an increased level of ApoB – in 19 (41%), IR – in 10 (22%). In patients with hyperleptinemia, serositis, positivity for anti-double-stranded DNA (aDNA) and hypocomplementemia were less common, overweight and obesity were more frequent, the SLEDAI-2K index was lower, the aDNA level was lower, and the concentration of the C3 component of complement, insulin, HOMA-IR index, body mass index (BMI) and disease duration were higher (p<0.05 for all cases). BMI <25 kg / m2 had 26 (57%) women, 14 (54%) of whom had hyperleptinemia. In patients with BMI <25 kg / m2, we found a relationship between leptin concentration and disease duration (r=0.4, p=0.04), SLE activity according to SLEDAI-2K (r=-0.6, p=0.003), levels of aDNA (r=-0.6, p<0.001), C3 component of complement (r=0.5, p=0.01), maximum (r=0.7, p<0.001) and supporting (r=0,5, p=0.023) GC doses.In patients with BMI ≥25 kg/m2 (n=20), no such relationship was observed.Conclusion. Hyperleptinemia was found in the majority of women with SLE; elevated levels of ApoB and IR were much less common. Patients with hyperleptinemia are characterized by a longer duration and less activity of the disease, as well as the presence of overweight and obesity and an increase in the HOMA-IR index. In SLE patients with normal body weight, the concentration of leptin increased along with GC dose elevation.