Международные и российские рекомендации по лечению ревматическиих заболеваний Ревматоидный артрит (РА)-иммуновоспалительное (аутоиммунное) ревматическое заболевание неизвестной этиологии, характеризующееся хроническим эрозивным артритом (синовитом) и системным поражением внутренних органов [1, 2]. В последние годы для лечения РА разработан широкий спектр инновационных генно-инженерных 1 ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой,

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Objectives Rheumatoid arthritis (RA) patients who fail to respond to methotrexate (MTX) can receive biologic disease-modifying antirheumatic drugs (bDMARDs). The Torque Teno Virus (TTV) is a potential novel candidate for monitoring of immunosuppression. We explore TTV in these patients and association with clinical response to bDMARDs. Methods The BioBio Study is a multicentre randomized open-label trial, including RA patients with insufficient response to MTX. Patients were randomized to either TNFi (infliximab, INF), anti-IL-6 (tocilizumab, TCZ), CTLA4-Ig (abatacept, ABA) or anti-CD20 (rituximab, RTX) in addition to MTX. PCR was used to quantify TTV in the peripheral blood. Results TTV was measured in 95 patients (INF, n = 23; TCZ, n = 22; ABA, n = 27; RTX; n = 23). TTV increased by a median of 4.5*104 copies/ml (c/ml; inter quartile range [IQR] 0–7.5*105) after 3 months. TTV levels at month 3 were associated with SDAI (p= 0.03) and CDAI response (p= 0.026) at month 6. A TTV cut-off level of 1.2*106 c/ml at month 3 had a positive likelihood ratio of 2.7 for prediction of SDAI85% response at month 6. Conclusion Our data suggest that TTV levels increase upon TNF, CD20 and co-stimulation blockade and associate with clinical response to bDMARDs in RA patients. Trial registration ClinicalTrials.gov; https://clinicaltrials.gov; NCT01638715

Background Rehabilitation of patients with rheumatoid arthritis (RA) – important medical and social problem. A complex rehabilitation program (CRP) must include different types of physiotherapy, orthoses, occupational therapy, patient education, exercises [1, 2]. Currently, the evidence for the effectiveness of early rehabilitation of patients with rheumatoid arthritis is scanty [2]. Objectives To evaluate the efficacy of the CRP for patients with early RA. Methods 36 patients with early RA were included. 20 patients underwent drug therapy and the CRP (exercise program for large joints under supervision of instructor 40 min, occupational therapy 40 min, local air cryotherapy of small joints of hands, knee or ankle joints at temperature –60°C, 15 min, 10 sessions), 16 received only drug therapy (control group). Average power left and right knees extension and ankles flexion were measured with the help of EN-TreeM movement analysis. Grip strengths of the hands, joint pain on 100-mm visual analog scale (VAS), Diseases Activity Score (DAS28), Health Assessment Questionnaire (HAQ), Rheumatology Assessment Patient Index Data (RAPID3) by Multi-Dimensional HAQ (R798–NP2) were evaluated. Results After the CRP pain on VAS decreased by 51,0% (60,4±22,4 mm vs. 29,6±17,5 mm, p<0,01), HAQ – by 33,1% (1,18±0,62 vs. 0,79±0,58, ΔHAQ=0,39±0,22, p<0,05), RAPID3 – by 46,0% (11,08±6,46 vs. 5,98±3,56, ΔRAPID3=5,10±0,45, p<0,01). Reduction of DAS28 (4,33±1,36 vs. 3,96±1,29, p>0,05) was not statistically significant. In the control group significantly decreased only pain on VAS by 30,1% (58,9±31,4 mm vs. 41,2±28,4 mm, p<0,05). After the CRP grip strength of the more affected hand enhanced by 27,4% (31,8±17,6 kPa vs. 40,5±22,3 kPa, p<0,05), of the less affected hand – by 20,0% (41,5±25,2 kPa vs. 49,8±20,8 kPa, p<0,05). Average power extension of the weaker knee joint of the patients with the damage of knee joints increased by 78,2% (3,72±2,29 W vs. 6,63±4,35 W, p<0,01), of the stronger knee joint – by 57,9% (5,85±3,21 W vs. 9,24±4,53 W, p<0,01). Average power flexion of the more affected ankle joint of the patients with the arthritis of ankle joints elevated by 68,9% (0,45±0,25 W vs. 0,76±0,37 W, p<0,01), of the less affected ankle joint – by 51,7% (0,58±0,29 W vs. 0,88±0,24 W, p<0,01). In the control group significantly increased only average power extension of the weaker knee joint by 20,9% (3,59±2,45 W vs. 4,34±2,95 W, p<0,05). At the end of the treatment, there were statistically significant differences between groups for most parameters. Conclusions This study showed that En-TreeM movement analysis makes it possible to quantify the functional status of every lower-extremity joint group. The CRP, which includes cryotherapy, exercise therapy and occupational therapy, helps to relieve pain, improves quality of life and increases functionality and motion activity (grip strength and power of motion) of RA patients immediately after the intervention. References Vliet Vlieland T.P.M. Rehabilitation of people with rheumatoid arthritis...

This article draws on the Narrative Policy Framework (NPF) to analyze the recent debates over Moscow's public transport policy. Despite a proliferation of NPF implementations in recent years, applications in authoritarian institutional settings remain rare. We seek to fill this gap by examining how the actors combine narrative strategies, characters, and plots to advocate their vision of public transport development in Moscow. To this end, this study tests NPF meso-level hypotheses on narrative strategies and their connections with plots and characters used in the context of Russian electoral authoritarian regime. The results show that the NPF hypotheses are applicable for the analysis of policy debates in an authoritarian context. While the governmental coalition uses an angel shift strategy-focusing on heroes, beneficiaries, and stories of control-to contain the scope of conflict, the opposing coalition implies a devil shift strategy with a specific attention to villains, victims, and different plots to expand the scope of conflict.