Rheumatoid and other inflammatory arthritis (ankylosing spondylitis and psoriatic arthritis) have a high risk of cardiovascular disease (CVD). It is caused by the accelerated development of atherosclerosis associated with a chronic systemic inflammatory process. Nevertheless, traditional CVD risk factors (hypertension, smoking, dyslipidemia) are also important for patients with inflammatory arthritis. The greatest amount of data has been accumulated regarding the relationship between CVD and rheumatoid arthritis. Due to the difficulties in diagnosing coronary heart disease and other CVD, it is of great importance to identify patients at high and very high risk. The use of scales for assessing the total cardiovascular risk SCORE/SCORE 2 with a coefficient of 1.5 allows to identify patients who need measures to reduce their high risk of CVD. Control of the of the disease activity, lifestyle modification, therapy with statins and antihypertensive drugs in accordance with current guidelines, caution when prescribing non-steroidal anti-inflammatory drugs and minimizing the dose of glucocorticoids are the main components of the strategy for reducing the risk of CVD in patients with inflammatory arthritis.

Aim. To determine serological markers of sarcopenia (SP) for use in general medical practice in people aged 65 years and older living independently.

Materials and methods. The study included 230 people aged 65 years and older (70 men and 160 women, median age 75 [68; 79] years) were consulted in a medical institution in St. Petersburg. The diagnosis of SP was made according to the criteria of EWGSOP2 (2018). The laboratory examination included clinical and biochemical blood analysis, determine the level of 25(OH)D, parathyroid hormone (PTH), C-reactive protein (CRP).

Results. The risk of SP increased at levels 25(OH)D less than 21 ng/mL (odds ratio 4.989; 95 % confidence interval 1.321–12.626; р = 0.0420), total protein less than 65 g/l (OR 8.567; 95 % CI 2.658–27.617; р = 0.00032), serum CRP 6 mg/l or more (OR 14.279; 95 % CI: 3.511–58.071; р = 0.00020) and decrease in the estimated glomerular filtration rate (eGFR) less than 62 ml/min/1.73 m2 (OR 12.108; 95 % CI 3.944–37.170; р = 0.00001).

Conclusion. Serological markers of SP, such as vitamin D, total protein, C-reactive protein in blood serum and eGFR can be used in general medical practice.

Aim. To determine the effect of visual impairment on the formation of visual hallucinosis.

Materials and methods. We studied 87 patients with Parkinson’s disease (PD). The average age of the patients was 65.16 ± 8.22 years. The patients underwent a comprehensive neurological and ophthalmological examination, including optical coherence tomography of the retina.

Results. The presence of visual hallucinosis was reported by 50.6 % of patients with PD. Extracampine hallucinations (ECH) are the most common. ECH was detected at all stages of PD and in patients with different forms of the disease and patients with ECH have no cognitive impairment. In patients with ECH, there was no decrease in visual acuity, impaired color perception, contrast sensitivity, as well as ophthalmic diseases such as cataracts, glaucoma, etc. An important difference between patients with ECH and patients without ECH was a statistically significant thinning of the retinal layers. Complaints about the presence of illusions were detected in 18.4 % of patients with PD. According to the results of our study, patients with illusions were characterized by a marked decrease in visual acuity, impaired color perception and contrast sensitivity, and, apparently, the presence of illusions in patients with PD can be explained by impaired visual perception and amblyopia. According to the results of neuropsychological testing, patients with illusions have impaired visual-spatial functions. Visual hallucinationsis appeared in the late-stages of PD, patients over 65 years of age with mild cognitive impairment.

Сonclusion. As a result of our study, it was revealed that the development of visual hallucinosis in patients with PD is associated not only with central (cortical) mechanisms, but the peripheral part of the visual analyzer is also of considerable importance, primarily retinal damage and loss of visual afferentation.

Aim. To study the predictors of a decrease in the quality of life of patients with Systemic Sclerosis (SSc) in the Russian population.

Materials and methods. The study included 60 patients with a reliable diagnosis of SSc: 58 women and 2 men. The average age of the respondents was 61 ± 12.8 years. 29 patients had a P-limited form of SSc, 29 also had a diffuse form, and 2 had a form of systemic scleroderma without scleroderma. The results of clinical, laboratory and instrumental examinations were evaluated, as well as data obtained using the following questionnaires: quality of life assessments The Short Form-36 (SF-36), physical and mental components of health, the modified British Medical Research Council dyspnea scale (mMRC), a visual analog scale for assessing the severity of fatigue. The relationship of clinical manifestations and complications of the disease with the quality of life of patients has been determined.

Results. The mean values of SF-36 (physical component) and SF-36 (mental component) in the examined patients were 36.08 ± 8.84 and 31.51 ± 12.7. Factors associated with poor quality of life in the physical component are the severity of shortness of breath (p < 0.001) and the presence of subcutaneous calcifications (p < 0.05), in the mental component – weakness (p < 0.001).

Conclusion. The quality of life of patients with SSc is reduced in both physical and mental components. The severity of shortness of breath, the presence of subcutaneous calcifications and weakness are the main predictors of a decrease in quality of life.

Introduction. A clinical case of an 80-year-old patient with clinical and instrumental manifestations of amyloidosis caused by the deposition of non-mutant (“wild type”) transthyretin (Amyloidosis “wild type” TransThyRetin, ATTRwt) is described. A special feature of this case was the diagnosis of amyloidosis at the same time as the identification of symmetrical polyarthritis.

Aim. To present an example of successful diagnosis and timely treatment of ATTRwt amyloidosis.

Materials and methods. Male patient (80 years old) consulted a rheumatologist in an outpatient clinic with complaints of weakness and pain in the muscles of the upper and lower extremities, swelling and soreness of both wrist joints; with manifestations of multiple tunnel syndromes (ulnar canal, Guyon canals, bilateral carpal tunnel syndrome). In addition, the patient had a heart involvement which appeared as left ventricle hypertrophy, paroxysmal form of atrial fibrillation, chronic heart failure with preserved ejection fraction, intraventricular conduction defect and low QRS voltage. Due to the presence of cardiac manifestations along with neuropathy, transthyretinic amyloidosis was suspected.

Results. Polyneuropathy was confirmed by the results of electroneuromyography. AL-amyloidosis (immunoglobulin Light chain Amyloidosis) is excluded due to the absence of monoclonal proteins in the blood. The diagnosis was confirmed by the results of scintigraphy with with labeled technetium-99m pyrophosphate. Intensive accumulation of radiopharmaceutical was detected in the myocardium of the left ventricle. The study also confirmed the presence of polyarthritis, manifested by increased accumulation, in the area of the I metatarsophalangeal joint on the left, both wrist, shoulder and knee joints. The hereditary nature of ATTR amyloidosis was excluded by the results of genetic analysis, which did not reveal mutations in the transthyretin gene. The singularity of this case was in development of a symmetrical polyarthritis during amyloidosis manifestation. Pathogenetic therapy with tafamidis was initiated. Arthritis regressed after starting treatment with methotrexate.

Conclusion. Transthyretin amyloidosis is a chronic progressive life-threatening disease caused by the formation and deposition of transthyretin-derived amyloid fibrils. The variety of amyloid tropicity to various organs and tissues leads to it phenotypic heterogeneity, which makes it difficult to make a diagnosis on early stages. However, the detection of «red flags» symptoms signaling the presence of transthyretin amyloidosis can shorten the time before initiation of targeted treatment, contributing to the improvement of the patient’s quality of life.

Back pain in young people (14–35 years old) may have causes rooted in adolescence or even earlier childhood. Diagnosis in this case can present considerable difficulties for a therapist and general practitioner, since “nonspecific back pain” may hide pathological conditions inherent in childhood. The degree of compensation for scoliosis, hereditary abnormalities in the development of the spine, the severity of early degenerative processes, and metabolic diseases of the skeleton that were not identified during school years determine a non-standard scope of diagnostic and therapeutic measures for the doctor. These include collecting a family history and screening the patient for the presence of inflammatory back pain according to the 2009 ASAS criteria, a survey on the hospital anxiety and depression scale, a morphometric assessment of the stigma of dysembryogenesis and an assessment of hypermobility syndrome, advanced laboratory diagnostics with determination of indicators of mineral-calcium metabolism, X-ray diagnostics with functional tests, the use of magnetic resonance imaging or computed tomography of the spine in the absence of radicular symptoms. The patient’s active involvement in non-drug restorative treatment significantly improves his prognosis, and pharmacological support should have a health-saving direction and consider the presence of low-intensity inflammation in the pathogenesis of the disease. The choice of therapy for a reproductively active cohort of patients is made in favor of drugs with the maximum safety profile, which include, among others, selective non-steroidal anti-inflammatory drugs.