Psoriatic arthritis (PsA) is a chronic immune-inflammatory progressive disease of the musculoskeletal system observed in psoriasis, which affects the joints, spine and entheses; it occurs in the form of arthritis, dactylitis, enthesitis, and can also manifest as spondylitis or sacroiliitis. The etiology of PsA is unknown, but the pathogenesis has been studied in more detail. Under the influence of external factors, such as infectious agents (viruses, bacteria, fungi), neuropsychic stress, injuries, drugs, changes in intestinal microbiota, etc., genetically predisposed individuals experience activation of the immune system, both congenital and acquired. Currently, there are 5 clinical forms of PsA: predominantly lesion of the distal interphalangeal joints of the hands and feet, distal form; mutilating arthritis; psoriatic spondylitis; asymmetric mono-oligoarthritis; symmetrical polyarthritis, rheumatoid-like form. Along with the characteristic symptomsof skin and joint damage, patients with PsA note a decrease in the quality of life, general malaise, fever, enlarged lymph Review nodes, weight loss, signs of comorbid pathology (obesity, diabetes, cardiovascular diseases). Arthritis is accompanied by tendinitis, synovitis, enthesitis. Isolated spinal damage (psoriatic spondylitis) is rare, it is usually combined with peripheral arthritis, characterized by pain in the spine, dysfunction, curvature. Differential diagnostics are carried out with rheumatoid arthritis, gout, ankylosing spondylitis, polyosteoarthritis, infectious forms of joint damage, joint damage in chronic inflammatory bowel diseases. Treatment of PsA should include medication, physiotherapy and spa treatment. Usually, treatment of PsA begins with the use of such drugs as methotrexate, leflunomide, sulfasalazine, cyclosporine A; non-steroidal anti-inflammatory drugs and intra-articular administration of glucocorticosteroids are used as an auxiliary agent, they are classified as symptom-modifying drugs, they partially improve the patient’s quality of life, reduce pain, but have little effect on the progression of the pathological process. In the absence of an effect from previously conducted treatment and contraindications, genetically engineered biological drugs are used.

To date, the consequences of progressive myocardial fibrosis are an urgent problem. Fibrosis is the basis for the progression of many cardiovascular diseases and leads to structural remodeling of the myocardium. Fibrosis isolates groups of cardiomyocytes and individual cells, disrupts the connection between them, which causes rhythm disturbances, including the development of atrial fibrillation. Fibrosis is the result of pathological remodeling in many tissues and contributes to the development of clinical diseases. At the moment, it is of great interest to identify means of slowing down and stopping the progression of tissue fibrogenesis. The progression of myocardial fibrosis is based on mechanisms that are associated with both cellular and molecular pathways. The main cellular element is an activated fibroblast, which produces a large amount of extracellular matrix. One of the main molecular mechanisms are transforming growth factor β, platelet-derived growth factor, connective tissue growth factor, vasoactive compounds (angiotensin II), cytokine-induced extracellular matrix pathways. It is these elements of the pathogenesis of the disease that can become the objects of new therapeutic interventions. This review article will present data on the prevalence and frequency of visits to medical institutions on issues related to developed gastric arrhythmias against the background of interstitial fibrosis, on the molecular processes involved in the initiation of myocardial fibrosis, as well as on non-coding RNAs regulating specific cellular signals, and on the studied therapeutic drugs inhibiting the transforming growth factor β signaling pathway. Generalized and structured information will help expand the understanding of molecular processes and, in the future, change approaches to the treatment of many heart diseases.

Aim. To study the prevalence of risk factors (RFs) such as dyslipidemia, impaired glucose metabolism, high heart rate (HR), obesity, smoking, stress, anxiety, and depression among patients with a confirmed diagnosis of hypertension (HTN) and individuals with elevated office blood pressure (BP) but without a diagnosis of HTN.

Material and methods. In the Ryazan region, as part of the state assignment of the Ministry of Health of the Russian Federation (the 2nd study under the ESSE program – “Epidemiology of cardiovascular diseases and their risk factors in the regions of the Russian Federation”), 1,632 people were examined, of whom those whose blood pressure did not fall below 140/90 mm Hg when measured twice were selected, (713 individuals). They were divided into 2 groups. Group A consisted of patients with a confirmed diagnosis of HTN, taking at least one antihypertensive medication (467 individuals, 62.7 % women, the median age was 52.0 years), and Group B consisted of individuals with elevated office BP but without a confirmed diagnosis of HTN and not taking antihypertensive medications (246 individuals, 41.1 % women, the median age was 44.0 years). A comparative assessment of RFs was conducted among them.

Results. A high prevalence of dyslipidemia was observed in the groups without statistical difference between them at 86.1 and 83.4 %, respectively (p > 0.05). However, frequency of impaired glucose metabolism was higher in patients of Groups A than that of Group B – 40.7 and 36.5 %, respectively (p = 0.004). The median body mass index (BMI) in Group A was 30.1 (26.8–33.4) kg/m2 , which was statistically significantly higher than the median in Group B, 29.3 (25.9–32.4) kg/m2 (p = 0.013). In Groups A and B, 13.9 and 16.6 % of individuals had normal BMI, 34.7 and 41.5 % had overweight, and 51.4 and 41.9 % had obesity, respectively, with no statistically significant difference between the groups in these measures. The smoking frequency was lower in Group A than in Group B, at 20.8 and 37.4 %, respectively (p < 0.001). The median HR in Group A was 73.0 (67.0–79.5) bpm and it was statistically significantly lower as compared with that of Group B –76.0 (70.0–82.0) bpm (p < 0.001), while the median of stress level (14.0 and 13.0 arbitrary units, p = 0.008), anxiety levels (6.0 and 4.5 arbitrary units, p < 0.001), and depression levels (5.0 and 4.0 arbitrary units, p < 0.001) were significantly higher in patients with HTN.

Conclusion. A high prevalence of dyslipidemia, excess body weight/obesity, and impaired glucose metabolism was found in both groups. However, in Group A as compared with with Group B, statistically significantly higher levels of fasting glucose, HBa1c, BMI, stress, anxiety, and depression were observed, as well as a lower frequency of smoking and increased HR. The higher smoking frequency among women and the lower prevalence of anxiety and depression in the Ryazan Region population with HTN as compared with nationwide studies may indicate regional characteristics of these RFs.

Aim. To present and clinically analyze a case of “injection drug users” infective endocarditis (IE) to increase awareness among general practitioners and cardiologists about this special variant of IE.

Materials and methods. Clinical observation of a 39-year-old female patient with long-term heroin and methadone addiction, viral hepatitis C, who was diagnosed with acute primary IE caused by methicillin-sensitive Staphylococcus aureus localized on the tricuspid and mitral valves. Bilateral septic pulmonary embolism and respiratory failure, secondary anemia, thrombocytopenia, nephrotic syndrome due to secondary glomerulonephritis were observed. On the 21st day of treatment, the patient underwent tricuspid valve replacement surgery with a biological prosthesis and multicomponent reconstruction of the mitral valve, the postoperative period was complicated by the development of exudative pericarditis.

Results. The clinical picture and the course of a complex case of “injection drug users” IE are discussed. The difficulties of early diagnostics of IE caused by the absence of pathognomonic clinical manifestations of the disease and the variability of the debuts of IE with the prevalence of extracardiac manifestations is highlighted. The principles of antibacterial therapy and indications for surgical treatment are reviewed.

Conclusion. Clinical observation draws the attention to the high probability of diagnosing IE in cases of fever in intravenous drug users and demonstrates both the difficulties of treatment and the possibility of a favorable outcome of this serious disease with timely diagnosis, appropriate antibacterial therapy, and early cardiac surgery.

Аim. To describe a clinical case of acute myocardial infarction in a young patient caused by spontaneous dissection of the coronary artery.

Material and methods. The patient, a 32-year-old man, was hospitalized in the cardiology department with a clinical picture of acute coronary syndrome. When collecting anamnestic data, it was established that the patient has an aggravated cardiovascular, hereditary, pharmacological anamnesis and concomitant pathology. A special attitude of the patient to hisdisease in the form of an anosognosic reaction was revealed. The data of the coronary angiography study determined further tactics of patient management at the inpatient stage.

Results. Taking into account the clinical picture, the dynamics of electrocardiograms, the results of laboratory diagnostics, acute myocardial infarction with ST segment elevation on the electrocardiogram was preliminarily diagnosed. During coronary angiography, spontaneous coronary artery dissection was detected in the patient, which was the main cause of acute left ventricular myocardial infarction. A decision was made to implant 3 stents in order to completely cover the dissection zone of the anterior interventricular branch of the left coronary artery. The choice of conservative and/or surgical tactics for managing patients with spontaneous coronary artery dissection is debatable. After percutaneous coronary intervention, drug therapy was prescribed, including dual antiplatelet therapy. The patient noted an improvement in his well-being, without relapses of pain syndrome. In the dynamics of inpatient treatment, according to echocardiographic examination, an aneurysm of the apex of the left ventricle with a mural thrombus was detected, which required correction of drug therapy, taking into account the increased risks of thromboembolic and hemorrhagic complications.

Conclusion. This clinical case demonstrates that spontaneous dissection of the coronary artery is one of the pathogenetic mechanisms of the formation of the clinical picture of acute coronary syndrome and affects the development of complications and further prognosis.

Osteoporotic vertebral fractures (OVF) are a severe complication of osteoporosis associated adverse outcomes, acute and chronic pain syndrome. If vertebral fractures (deformities) are detected, osteoporosis is diagnosed regardless of bone mineral density and the 10-year absolute fracture risk scale of the Fracture Risk Assessment Tool, but subject to the exclusion of other metabolic osteopathies. The article presents differential diagnosis of OVF with osteopathies such as osteomalacia, tumors or metastatic lesions of the spine, Paget»s disease, myeloma, hyper parathyroid osteodystrophy, post-traumatic vertebral deformities, Scheuermann-Mau disease. Differential diagnosis between different types of osteopathies is based on features of the clinical picture, history, changes in laboratory parameters (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D3 and on data from X-ray of the skeleton examination. It is necessary to take into account conditions under which the vertebral fracture occurred, its localization, prevalence, peculiarities of changes in bone structures, presence or absence of osteoporotic background, degenerative-dystrophic changes in the spine. The tactics of managing the patients with OVF is determined by the time after the fracture, its severity, nature of the pain syndrome and includes non-drug and medical measures. Among non-pharmaceutical measures in the acute period of OVF, there are unloading of the spinal column, use of a corset, and physical therapy. Medical measures are aimed at pain relief using injectable and oral forms of nonsteroidal anti-inflammatory drugs, central acting muscle relaxants and anti-osteoporotic therapy. Dexketoprofen (Dexalgin) is the first-line drug for relief of acute pain in OVF which has a rapid and pronounced analgesic effect. For the anti-osteoporotic therapy, the drugs of choice are parenteral bisphosphonates, denosumab and teriparatide.

Aim. To consider new mechanisms of gout pathogenesis of and possibilities of influencing the pathological process. Gout is a chronic joint disease caused by the deposition of monosodium urate crystals in various tissues and subsequent inflammation in individuals with hyperuricemia, caused by exocrine and/or genetic factors. In recent years, new knowledge about gout diagnostics, genetics, pathogenesis, comorbidities and various data indicate new strategies to improve control of the disease and its exacerbations, as well as to prevent comorbid conditions. The discovery of new mechanisms concerning sodium monourate crystal-induced inflammation, proposed new methods of treating not only gout, but also other systemic diseases, including renal and cardiovascular diseases using xanthine oxidase inhibitors, including febuxostat. The case of colchicine is very indicative, which recently, taking into account the significant results of laboratory and clinical experiments, received approval from the US Federal Food and Drug Administration for the Prevention of cardiovascular Diseases. This has provided opportunities for the combinedadministration of febuxostat and colchicine to treat gout, recurrent arthritis attacks and reduce the risk of cardiovascular complications.