Nadezhda A. Shostak

Generalized osteoarthritis (GOA) is a clinical variant of osteoarthritis characterized by multiple joint involvement, including the joints of the hands, knees, hips, and the spinal joints. This article presents the evolution of the knowledge about GOA from the classic works of J.H. Kellgren and R. Moore (1952) to modern approaches addressing multi-joint osteoarthritis. Various definitions of multi-joint osteoarthritis are analyzed, demonstrating their dependence on the number of involved joint groups and their impact on the assessment of disease prevalence. Special attention is paid to the axial component of GOA: involvement of intervertebral discs and facet joints is considered as a single clinical and morphological phenotype with common pathophysiological mechanisms (inflammation, angiogenesis, extracellular matrix remodeling). Current diagnostic approaches are presented, including clinical assessment, instrumental methods, and promising biomarkers. A phenotype-oriented approach to the treatment of GOA is substantiated.

Aim. To identify prognostically unfavorable predictors of loss of ability to work in patients with systemic sclerosis. Material and methods. The analysis included 60 patients of working age (mean age 50.18 ± 9.86 years) with confirmed diagnosis of systemic sclerosis established based on the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria (2013). The ratio of men to women was 1:5. Median duration of the disease from the onset of Raynaud’s phenomenon was 7.5 (interquartile range from 3 to 17.5) years, and from the first symptom not related to Raynaud’s phenomenon – 6.5 (interquartile range from 2 to 12.5) years. The severity of clinical, laboratory, and instrumental characteristics of systemic sclerosis, the level of anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS), the degree of reduction of quality of life according to the SF-36 questionnaire, the degree of functional disorders according to the Health Assessment Questionnaire (HAQ) and the Sclerosis Health Assessment Questionnaire (SHAQ) were assessed. The severity of dyspnea was evaluated using the modified Medical Research Council (mMRC) scale. All patients included in the analysis were divided into two groups based on their status: employed or unemployed (due to systemic sclerosis). In this study, ability to work and the status of an employed were considered synonyms. The “unemployed” category included patients who had lost their ability to work due to systemic sclerosis. Patients unemployed for other reasons were excluded from the study. Results. Univariate analysis using binary logistic regression showed that significant predictors of loss of ability to work are functional disorders HAQ ≥0.43 (odds ratio (OR) 17.82; 95 % confidence interval (CI) 3.04–104.61; p 0.001), SHAQ score 0.71 (OR 13.51; 95 % CI 2.53–72.06; p = 0.002), low physical health score per the SF-36 PCS (Physical Component Summary) 36.24 (OR 0.9; 95 % CI 0.84–0.96; p = 0.001), depression per the HADS-Depression scale ≥7 (OR 1.21; 95 % CI 1.03–1.42; p = 0.02), dyspnea per the mMRC ≥2 (OR 3.63; 95 % CI 1.68–7.81; p 0.001), systolic pressure in the pulmonary artery 27.5 mmHg (OR 1.21; 95 % CI 0.07–1.37; p = 0.002), tricuspid regurgitation velocity ≥2.4 m / s (OR 1.04; 95 % CI 1.01–1.07; p = 0.001), decreased distance in the six minute walk test ≤500 m (OR 1.63; 95 % CI 1.16–2.29; p = 0.011), decrease in forced vital capacity ≤90 % from predicted (OR 1.21; 95 % CI 1.03–1.43; p = 0.02), manual labor (OR 16.2; 95 % CI 1.57–167.74; p =0.02). Multivariate analysis using multiple logistic regression with sensitivity 84.6 % and specificity 85.3 % showed that loss of ability to work in systemic sclerosis is affected by dyspnea level per the mMRC ≥2 (OR 33.5; 95 % CI 3.05–367.81; p = 0.004) and tricuspid regurgitation velocity ≥2.4 m / s (OR 69.8; 95 % CI 7.75–625.04; p 0.001). Conclusion. The importance of assessing the severity of dyspnea using the mMRC scale and tricuspid regurgitation velocity as determined by echocardiography in relation to predicting the loss of work ability underscores the necessity of evaluating these parameters in routine rheumatological practice.

BACKGROUND. The reduction in mass and function of paraspinal muscles and its contribution to axial instability and the development of back pain has become an active area of research. However, current diagnostic criteria for sarcopenia have limitations when applied to spinal sarcopenia. The condition of the spinal muscular system in patients with chronic back pain and degenerative spine disorders is of interest not only for treatment but also for disease prevention. OBJECTIVE. To assess the paraspinal muscle mass in patients with low back pain across different age groups using magnetic resonance imaging (MRI). MATERIALS AND METHODS. A total of 93 patients with low back pain were included in the study: young adults (n = 35, Me: 36.00 [30.00–42.00]), middle-aged (n = 30, Me: 50.00 [46.50–56.25]), and elderly patients (n = 28, Me: 66.00 [62.50–71.00]). Back pain intensity was measured using a Visual Analogue Scale (VAS, mm), and spinal function was assessed using the Backache Index (BAI). Intervertebral disc (IVD) degeneration was evaluated via MRI according to the Pfirrmann classification (2001). The cross-sectional areas of paraspinal muscles (psoas major, erector spinae, quadratus lumborum) were measured on axial MRI slices at the level of the third lumbar vertebra (L3). The muscle-to-vertebral index (MVI) was calculated by dividing the total cross-sectional area of the three paired muscles (Sm, cm2) by the crosssectional area of the L3 vertebral body at its superior endplate (Sv, cm ² ): MVI = (Smdextra + sinistra) / Sv. The anterior-posterior body dimension was also measured on sagittal slices at the upper edge of L3. RESULTS. Chronic back pain was reported in 80%, 83.3%, and 86.7% of the young, middle-aged, and elderly groups, respectively. The BAI scores indicating significant spinal dysfunction (0.80 [0.47–0.90], 0.67 [0.50–0.77], and 0.80 [0.65–1.00] respectively) positively correlated with VAS pain intensity across all subjects (r = 0.55, p < 0.0001). Obesity was twice as prevalent among elderly patients compared to younger and middle-aged individuals (30.0% vs. 14.3% and 16.7%, respectively). The mass of the paraspinal muscles according to the average MVI values in the groups was statistically lower in middleaged (p = 0.025) and elderly (p = 0.0001) individuals. Asymmetry of the quadratus lumborum muscle (right side larger than left) was identified in all patients (p < 0.05). An age-related increase in the cross-sectional area of the L3 vertebral body endplate was also found (p = 0.0003). A positive correlation was observed between the anterior-posterior torso dimension and the stage of IVD degeneration at L5–S1 (р = 0.054; r = 0.29). CONCLUSION. Paraspinal muscle mass in patients with back pain and degenerative spine disease decreases with age (p < 0.05), as reflected by reduced MVI values on MRI. The MVI is an effective tool for evaluating paraspinal muscle loss. Altered motor patterns lead to chronic imbalance and asymmetry of the quadratus lumborum muscle in all age groups studied. The increase in the vertebral body’s endplate area may reflect adaptive changes aimed at maintaining axial spinal stability. The positive correlation between the anterior-posterior body dimension and IVD degeneration suggests a contribution of the musculoskeletal-visceral component to the condition of the lumbar spinal motion segment.

Degenerative disc disease (DDD) is a major cause of chronic low back pain (LBP), yet the molecular mechanisms driving disc degeneration and pain remain poorly understood. This study analyzed intervertebral disc (IVD) tissue from 36 young patients (median age = 36.00 [31.00, 42.50] years) with herniated discs and LBP, alongside healthy controls, to investigate changes in the extracellular matrix (ECM) and neurochemical alterations. Disc degeneration was assessed using MRI (Pfirrmann grading) and histology (Sive’s criteria). Histochemical and immunohistochemical methods were used to evaluate aggrecan content, calcification, and the expression of nerve growth factor (NGF), substance P (SP), and S-100 protein. MRI findings included Pfirrmann grades V (30.55%), IV (61.11%), III (5.56%), and II (2.78%). Severe histological degeneration (10–12 points) was observed in three patients. Aggrecan depletion correlated with longer pain duration (r = 0.449, p = 0.031). NGF expression was significantly elevated in degenerated discs (p = 0.0287) and strongly correlated with SP (r = 0.785, p = 5.268 × 10⁻⁹). Free nerve endings were identified in 5 cases. ECM calcification, present in 36.1% of patients, was significantly associated with radiculopathy (r = 0.664, p = 0.005). The observed co-localization of NGF and SP suggests a synergistic role in pain development. These results indicate that in young individuals, aggrecan loss, neurochemical imbalance, and ECM calcification are key contributors to DDD and chronic LBP.

Introduction: Degenerative disc disease (DDD) is a major cause of lower back pain (LBP). Key pathological processes of intervertebral disc (IVD) degeneration include extracellular matrix (ECM) degradation (including aggrecan loss), cartilage dehydration, and pathological ingrowth of blood vessels and nerve fibers. Neurotrophins and neuropeptides, such as nerve growth factor (NGF) and substance P (SP), play an essential role in LBP pathogenesis, neoinnervation, inflammation, and the maintenance of chronic pain. Materials and Methods: Thirty-six young patients (mean age 36.00 [31.00, 42.50] years) with LBP associated with herniated discs and five healthy individuals were enrolled. IVD samples were collected during microdiscectomy. MRI-based Pfirrmann classification (2001) was used to assess the stages of disc degeneration. Histological grading was performed according to Sive’s criteria (2002). Histochemical staining (hematoxylin-eosin, Alizarin Red, Safranin O/Fast Green FCF) was conducted to evaluate ECM status, including aggrecan content. Immunohistochemical analysis was performed to assess NGF, S-100 protein, and SP expression. Results: All patients experienced chronic LBP. According to MRI, Pfirrmann grade V degeneration was found in 30.55% of patients, grade IV in 61.11%, grade III in 5.56%, and grade II in 2.78%. Histologically confirmed degeneration was observed in 23 cases (63.88%), with 3 patients showing severe degeneration (10-12 points). In patients with longer pain episodes (average duration 11.29 weeks), aggrecan loss was observed in 19.4% of cases (r=0.449; P=0.031). NGF expression was significantly higher in degenerated discs (P=0.0287) and positively correlated with SP levels (r=0.785; P=5.268 × 10 ⁻⁹ ). Increased NGF and SP expression were noted in patients with osteophytes, with levels correlating with both the histological degeneration score and MRI grading. Isolated free nerve endings were detected in the nucleus pulposus of 5 patients. Calcification was observed in 36.1% of cases, predominantly around hypertrophic chondrocytes and their clusters, and its severity correlated with radiculopathy (r=0.664; P=0.005). Conclusion: In young individuals, aggrecan loss, increased expression of NGF, SP, S-100 protein, and ECM calcification are key pathological features of IVD degeneration contributing to chronic LBP. The colocalization of NGF and SP suggests a synergistic role in the development of chronic pain. These findings highlight new therapeutic targets aimed at inhibiting pathological neoinnervation and ECM degradation.

Aim. To illustrate a comprehensive approach to management of a patient with long-standing generalized tophaceous gout, taking into account concomitant comorbidities, as well as to analyze the factors influencing adherence to therapy and lifestyle modification.Material and methods. Patient N., 54 years old, with a 16-year history of gout, multiple tophi, hyperuricemia, stage C2 chronic kidney disease (glomerular filtration rate 69.8 ml/min/1.73 m2), dyslipidemia, grade 1 obesity, and nephrolithiasis. A comprehensive clinical, laboratory, and instrumental diagnostic evaluation was performed, and the nature of joint changes and the comorbidity degree were verified. Specialists prescribed uric acid-lowering therapy with febuxostat (80 mg/day), along with preventing therapy for recurrent gouty arthritis using colchicine (0.5 mg/day), rosuvastatin (10 mg/day), and measures for dietary and weight correction.Results. Against the background of the ongoing therapy, a sustained clinical and laboratory effect was achieved over four months: serum uric acid levels decreased to 282 µmol/L, no arthritis recurrences were recorded, and positive dynamics in the volume of tophaceous infiltration were observed. The patient demonstrates a high level of compliance, following the treatment regimen and recommendations on diet and physical activity.Conclusion. Modern management of gout requires a comprehensive approach that includes pharmacotherapy and lifestyle modification. However, in practice, only a few patients achieve target uric acid levels, indicating the need to strengthen prevention, educational programs, and improve adherence to treatment.

Introduction. Current strategies for treating osteoarthritis (OA) are based on a multimodal approach that includes pharmacological and non-pharmacological methods. Undenatured chicken collagen type II (NK2) is considered safe and effective for maintaining joint health and can be used alone and combined with drugs for OA treatment. Aim. To further evaluate the efficacy of the combination of Artneo containing NK2 in patients with stage III knee OA compared with placebo in a multicenter, prospective, double-blind, placebo-controlled, randomized trial. Materials and methods. The study included 212 patients from 12 centers in the Russian Federation, of whom 50 had radiological stage III knee OA: 41 (82.0%) females and 9 (18.0%) males aged 44 to 75. Using the interactive web response system (IWRS), the study population was randomized into two groups: Group 1 (Artneo group) included 28 patients receiving the drug 1 capsule once a day for 180 days, Group 2 (placebo group) included 22 patients receiving placebo with drug-matched presentation and the same regimen as in Group 1. The effectiveness of therapy was assessed by the change of pain using the Visual Analog Scale, the WOMAC index, KOOS, the EQ-5D quality of life questionnaire, and the need for non-steroidal anti-inflammatory drugs. All patients had a complete blood count, urinalysis, blood chemistry, and ultrasonic examination of the target knee joint. Results. A prospective, double-blind, placebo-controlled, randomized trial demonstrated that Artneo containing NK2 was significantly superior to placebo in all studied parameters, improved all clinical manifestations of OA: reduced pain and stiffness, improved joint function and quality of life, and had a good safety profile. Conclusion. Artneo showed high efficacy and safety in the general population of patients, including those with stage III knee OA.

Introduction: Sarcopenia of the spinal stabilizing muscles is one of the components of age-related sarcopenia and often associated with chronic back pain (CBP), including spinal osteoarthritis (OA). The age dynamics of paraspinal muscle mass in spinal OA is not sufficiently studied to date, although it is key in developing rehabilitation and prevention strategies. The aim of study: is to identify spinal sarcopenia in individuals with spinal OA by assessing paraspinal muscles mass and analyzing its relationship to degenerative spinal changes in different age groups using magnetic resonance imaging (MRI). Materials and methods: The study included 90 patients with spinal OA classified as stages 4 and 5 of degenerative disc disease according to the Pfirrmann grading system. Participants were evenly distributed across three age groups: young adults (Me: 36.00 [30.00-42.00]), middle age (Me: 50.00 [46.50-56.25]), and elderly (Me: 66.00 [62.50-71.00]). All participants underwent lumbar spine MRI in two sections – sagittal and axial – in T1- and T2-weighted images. Clinical assessments included evaluating the functional status of the lumbar spine using the Backache Index (BAI). Paraspinal muscle mass analysis was performed on axial sections at the level of the third lumbar vertebra (L3) for the following muscles: musculus psoas major, musculus erector spinae, and musculus quadratus lumborum. To comparatively assess spinal muscle mass, the musculovertebral index (MVI) was calculated by dividing the total cross-sectional area of the three pair muscles (Sm, cm²) by the cross-sectional area of the third lumbar vertebra (Sv, cm²) at the upper endplate level: MVI = (Sm dextra + Sm sinistra) / Sv. To identify the asymmetries of the paraspinal muscles, the ratio of the cross-sectional areas of the three muscles on the left and right sides was calculated. Additionally, the transverse torso thickness at L3 level was measured on sagittal sections. Results: The mean MVI values demonstrated that paraspinal muscle mass was significantly lower in elderly (p = 0.0001) and middle-aged (p = 0.025) groups compared to the young group, which indicates its decrease with age in patients. Statistically significant increase in the lumbar vertebra area with age (p=0.0003 young vs elderly) is explained by the spondylosis development and age-related marginal osteophyte growth as manifestations of spinal OA. The reduction in muscle cross-sectional area was evident for three right paraspinal muscle groups with age (p = 0.0252). Asymmetry for each pair of muscles was observed across all age groups, the right side always being larger than the left, particularly in the quadratus lumborum, where it was most pronounced in middle-aged (p = 2.762 × 10 ⁻⁶ ) and young individuals (p = 0.0009). The elderly persons demonstrated a tendency toward higher body mass index, a higher percentage of obese individuals, and increased torso thickness compared to the middle-aged and young groups (p = 0.067), suggesting a possible decline in abdominal muscle tone with age alongside body weight gain. Conclusions: MRI findings reveal an age-related decline in paraspinal muscle mass among patients with CBP, indicating the development of spinal sarcopenia, which likely contributes to the clinical course of spinal OA in the elderly. All three groups of muscles show asymmetry in all age groups, with the right side always being larger than the left. Torso thickness and body weight increase with age in patients with spinal OA potentially exacerbate the disease’s clinical progression. These findings highlight the need to include exercises targeting paraspinal and abdominal muscles in rehabilitation programs for patients with spinal OA in all age groups. Preventing spinal spinal sarcopenia by maintaining axial muscle stability is essential for preserving the spinal muscle framework and is an integral component of managing patients with CBP.

Metabolic syndrome (MS) is a complex of metabolic disorders, including insulin resistance, abdominal obesity, diabetes mellitus, hyperuricemia and arterial hypertension. According to the World Health Organization, the number of people with obesity worldwide is steadily increasing, taking on the characteristics of a “pandemic”. Against this backdrop, diseases pathogenetically linked to MS, such as osteoarthritis (OA), are gaining particular significance. Modern biochemical and molecular-genetic research has provided new data on the etiology and pathogenesis of OA, allowing the identification of phenotypes of the condition. One such phenotype is OA associated with MS, or metabolic OA. The development of this form of the disease is influenced by numerous factors, including hypersecretion of pro-inflammatory adipokines, transformation of synovial macrophages, direct effects of free fatty acids, biomechanical overload of joints, and others. Treatment of metabolic OA, in addition to standard approaches outlined in numerous clinical guidelines, has its own specific features. Particular emphasis is placed on weight reduction through lifestyle modification, strengthening of musculo-tendinous complexes, and concomitant therapy for metabolic disorders. These measures have demonstrated significant therapeutic effects, including pain reduction, decreased inflammation, and slowing of disease progression. One of the modern comprehensive remedies with phytonutritional components is Revocca capsules (“BIOTECHNOS”, Russia). Their composition in daily dosage includes phytosterols (calculated as β-sitosterol) at 100 mg, unsaponifiable compounds from avocado and soybean oils (in a 1:2 ratio) at 300 mg, rosehip extract at 300 mg, resveratrol at 70 mg, and zinc (as zinc citrate) at 12 mg. Given the increasing number of patients with the metabolic phenotype of OA, comprehensive hypolipidemic and anti-inflammatory therapy provided by multi-component drugs is becoming increasingly significant.

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.