Samal M. Issayeva

Введение. Коморбидная патология, сопровождающая большинство хронических неинфекционных заболеваний, не только негативно влияет на лечение пациентов, но и значительно ухудшает их качество жизни. Остеоартрит (ОА) - заболевание, ассоциированное с возрастом и характеризующееся высокой коморбидностью. Цель исследования: выявить наиболее часто встречающиеся коморбидные состояния у пациентов с ОА. Материалы и методы: Дизайн исследования: Исследование является проспективным, контролируемым. Период проведения исследования с 01 сентября по 01 декабря 2022г. в КГП на ПХВ «Городской поликлиники» №5. Обследовано 60 больных с достоверным диагнозом ОА, из них 12 мужчин (20%), 48 женщин (80%), средний возраст (63,37±10,1 лет), средняя длительность болезни (6,89±7,45). Все пациенты подписали информированное согласие до начала исследования. Статистическую обработку полученных данных осуществляли с помощью программы Statistica-6, где p<0,05 считали их достоверными. Результаты. В основном преобладали женщины 80%, старше 50 лет. Из 60 пациентов ОА гонартроз выявлен у 44 (73,3%), коксартроз у 4 (6,7%), генерализованная форма – у 12 (20%), с превалированием больных со IIрентгенологической стадией. Сопутствующие заболевания имели все 60 пациентов с ОА, из них с наличием двух и более коморбидных патологий было 92,2%. Ведущее место в структуре коморбидности занимала патология сердечно-сосудистой системы у 31 (51,7%), в том числе артериальная гипертензия (АГ) у 18 (58%), ишемическая болезнь сердца (ИБС) - 13 (42%) пациентов, при этом преобладала стенокардия напряжения II функционального класса. Среднее систолическое давление исходно и в динамике составило 123,39±17,02 мм рт. ст., показатели диастолического давления исходно и в динамике были в пределах 82,62±5,05. На втором месте эндокринная патология у 16 (26,7%) больных. 6 (10%) пациентов имели остеопороз (ОП) и получали бисфосфонаты. Выводы. Практически все пациенты ОА имеют коморбидную патологию, при этом в 92,2% случаев пациенты имеют два и более сопутствующих заболевания. Наиболее частыми сопутствующими патологиями являются заболевания сердечно-сосудистой системы (51,7%, в том числе АГ – у 58% пациентов), болезни эндокринной системы у 16 пациентов (26,7%), из них ожирение у 8 (50%), сахарный диабет (СД) 2 типа у 5 (31,3%), гипотиреоз – у 3 (18,7%) соответственно и ОП у 10% пациентов. Introduction. Comorbid pathology, which accompanies most chronic non-communicable diseases, not only negatively affects the treatment of patients, but also significantly worsens their quality of life. Osteoarthritis (OA) is an age-related disease characterized by high comorbidity. Aim: to identify the most common comorbid conditions in patients with OA. Materials and methods: Study Design: The study is prospective, controlled. The study period is from September 01 to December 01, 2022. in the KGP on the REM "City Polyclinic" No. 5. 60 patients with a reliable diagnosis of OA were examined, including 12 men (20%), 48 women (80%), mean age (63.37±10.1 years), mean duration of illness (6.89±7.45). All patients signed an informed consent prior to the start of the study. Statistical processing of the obtained data was carried out using the Statistica-6 program, where p<0.05 was considered significant. Results. Mostly dominated by women 86.7%, over 50 years old. Out of 60 patients with OA, gonarthrosis was detected in 44 (73.3%), coxarthrosis in 4 (6.7%), generalized form - in 12 (20%), with the prevalence of patients with X-ray stage II. All 60 patients with OA had concomitant diseases, of which 92.2% had two or more comorbid pathologies. The leading place in the structure of comorbidity was occupied by pathology of the cardiovascular system in 31 (51.7%) patients, including arterial hypertension (AH) in 18 (58%) patients, coronary heart disease (CHD) in 13 (42%) patients, with this was dominated by angina pectoris II functional class. The mean systolic pressure at baseline and over time was 123.39±17.02 mm Hg. Art., indicators of diastolic pressure initially and in dynamics were within 82.62±5.05. In second place is endocrine pathology in 16 (26.7%) patients. Six (10%) patients had osteoporosis (OP) and received bisphosphonates....

Glucocorticoids (GC) and immunosuppressants (IS) are traditional treatments for vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), often resulting in the development of infections, diabetes mellitus and other adverse events (AEs). The development of a steroid-sparing strategy using biologic disease-modifying antirheumatic drugs (bDMARDs, including rituximab, etc.) and synthetic targeted drugs (avacopan) has radically improved the course of the disease. Currently, there are increasing number of basic and clinical trials of numerous bDMARDs that effectively reduce the number of AEs associated with GC and IS. The steroid-sparing therapeutic strategy not only shows considerable efficacy, but also opens up new perspectives for the treatment of patients with ANCA-associated systemic vasculitis.

Objective: to evaluate the efficacy and safety of the biosimilar etanercept (ETC, Altebrel) in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) in clinical practice.Material and methods. The study included 20 patients with a confirmed diagnosis of RA and 8 with SpA: 5 with axial SpA with radiological signs of sacroiliitis (r-axSpA), 3 with peripheral psoriatic arthritis (PsA). The mean age of the patients with RA was 47.7±12.3 years, and the mean age of SpA patients was 40.4±15.9 years. Patients with RA had moderate or high disease activity: mean DAS28-ESR index 5.2±1.0, median CDAI – 22.5 [15.5; 35.0], SDAI – 31.9 [24.4; 38.6], CRP level – 11 [0.9; 32.5] mg/L. Patients with r-axSpA had high activity and functional impairment, the median BASDAI was 5.5 [3.5; 8.0], BASFI – 6 [4; 6], CRP level – 17.5 [12.5; 27] mg/L. In PsA, the average DAS28 was 6.25±0.71. All patients were prescribed Altebrel at a dose of 50 mg subcutaneously weekly against a background of disease-modifying antirheumatic drugs. Patients were examined at baseline and then after 3 and 6 months of treatment.Results and discussion. During treatment with the biosimilar ETC, all patients with RA showed a decrease in inflammatory activity markers: after 3 and 6 months of therapy, the mean DAS28-ESR value decreased to 3.5±1.2 and 2.3±0.7 (p Conclusion. The results of the study demonstrate the high efficacy of Altebrel in rheumatic diseases, including RA and SpA.

Vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA) are a group of systemic autoimmune diseases characterized by necrotizing lesions of the walls of predominantly small vessels and the presence of ANCA against proteinase 3 or myeloperoxidase. However, an increase in ANCA levels can also be observed in other diseases, including autoimmune, malignant and infectious diseases, which complicates the interpretation of clinical and laboratory data and requires a differential diagnosis.

Objective – to evaluate the features of clinical manifestations, course, outcomes and quality of life related to health in patients with systemic lupus erythematosus in the Republic of Kazakhstan.Patients and methods. The study included 102 patients with systemic lupus erythematosus (SLE) with a reliable diagnosis according to SLICC (2012). Disease activity was assessed by the SLEDAI 2K index, organ damage (IOD) by SLICC/ACR (2000). Statistical processing was carried out using SPSS 13 software (IBM Corp., USA). Variables with a parametric distribution are presented as М±SD, nonparametric – as a median (Me) [25th; 75th percentile].Results and discussion. The cohort was dominated by female patients (98%), Asians (83.33%), young patients (33.85±10.58 years) with a disease duration of 5 [2; 9] years with high (30.8%) and very high (39.2%) degree of activity (SLEDAI-2K – 17.64±8.80 points). The debut of the disease was in 18.6% of patients in adolescence, it was characterized by an unfavorable course. Clinical manifestations of the disease: skin lesions (acute active and chronic forms) (98%), joints (79.4%), non-scarring alopecia (75.5%), neuropsychiatric disorders (49%), mucous membranes (46.1%), hematological (54.9%) and immunological disorders (100%). IOD: low – in 20.6%, medium – in 59.8%, high – in 9.8% of patients, 0 – in 9.8%, Risk factors for poor outcome were in 93.1% of patients. Assessment of health-related quality of life (HRQOL) in SLE patients showed a significant decrease on all scales. Correction of the treatment program, taking into account the factors of adverse outcome (FRNI), consisted in strengthening therapy with the inclusion of genetically engineered biological drugs (GEBP).Conclusion. SLE is a socially significant disease in Kazakhstan with a high incidence rate (101%) over 10 years (2009–2018). The cohort of SLE patients is dominated by young people, females. The duration of the disease is up to 5 years with a delayed verification of the diagnosis of SLE. Organ damage is already in the onset of the disease and the presence of FRNI of the disease in 93.1% of patients, which indicates the severity of the course, which requires early diagnosis and active involvement of pathogenetic treatment, including GEBD.

BACKGROUND: Osteoporosis is a multifactorial systemic skeletal disease characterized by a decrease in bone strength leading to an increased risk of fractures. Hip fracture is a serious complication of osteoporosis. It is expected in Kazakhstan by 2050 the annual number of hip fracture will increase by 140% compared to 2015 data and will amount to 28,048 cases. There are differences in the incidence of fractures and low bone mineral density in different ethnic groups. However, low bone mineral density is only one of many risk factors for osteoporotic fractures. AIM: To study the risk factors of osteoporosis and related osteoporotic fractures in patients with hip fracture living in Kazakhstan. MATERIALS AND METHODS: The case-control study included 98 patients with hip fracture of Kazakh (main group, n = 49) and other nationalities (control group, n = 49). In the registration card, risk factors for osteoporosis and osteoporotic fractures from the Fracture Risk Assessment (FRAX) model were distinguished, and the Find cases Assess Confirm Severity algorithm (2019) was used to diagnose sarcopenia. Statistical analysis was carried out using the Statistics 26 (IBM SPSS, США). RESULTS: The groups were comparable in terms of gender, disability, fracture location and functional activity, surgical treatment. An increase in cases of hip fracture at an older age was found in the main group than in the control group (р = 0.035). There were no differences in the groups for clinical risk factors for osteoporotic fractures (body weight, height, history of fractures, family history of fractures, medication, comorbidity), except for smoking (lower in Kazakhs than in the other group) (р = 0.033). Differences in 10-year probability of major osteoporotic fracture and hip fracture between groups (р = 0.34 and р = 0.74) were not found. The proportion of patients who entered the intervention threshold and at low risk did not differ in the groups (р = 0.623). The average SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) score was lower among Kazakhs (р = 0.011), there is a difference between the groups when walking (р = 0.044), climbing stairs (р = 0.003). A decrease of grip strength was noted in the main group (р = 0.008), especially in men (р = 0.011), but low grip strength (р 0.001) and signs of sarcopenia (р 0.001) were determined only by age, not nationality. CONCLUSIONS: The Fracture Risk Assessment (FRAX) model and intervention threshold can be applied to all residents of Kazakhstan.

Objective: to study and analyze the dynamics of prevalence, demographic, social, and clinical manifestations of systemic lupus erythematosus (SLE) in patients living in Kazakhstan.Materials and methods. Official materials of the Ministry of Health of the Republic of Kazakhstan (2009–2018): statistical compendiums, a consolidated reporting form for medical treatment (N 12). 102 patients (100 women and 2 men) were included in the register of SLE with reliable SLE according to SLICC (ACR, 2012). Assessment of the debut of the disease was carried out according to archival material (medical history, outpatient records) of patients. The activity of the process was evaluated according to SLEDAI-2K, organ damage according to SLICC/ACR (2000).Results. The total number of patients with SLE over 10 years (2009–2018) more than doubled, the growth rate was 101%. The overwhelming majority of patients with SLE are women (91%). In the study group, Asians (83.33%) predominated by race, of which Kazakhs (76.47%) were young (mean age – 33.85±10.58 years), with a disease duration of 5 (2; 9) years, time from the appearance of the first signs to verification of SLE – 4.5 (3; 12) years. The prevailing acute (49.0%), subacute (33.3%), rather than chronic (18.7%) variants of the course, with high activity according to SLEDAI-2K – 17.64±8.80. The most common clinical manifestations of the disease: skin lesions (98%), joints (79.4%), nervous system (49%), hematological (54.9%) and immunological (100%) disorders. The absence of organ damage (0 points) was detected in 10 (9.8%) cases, low (1 point) – in 21 (20.6%), medium (2–4) – in 61 (59.8%), high (over 4) – in 10 (9.8%) patients.Conclusion. SLE remains a socially significant disease in Kazakhstan, as evidenced by the dynamics of the increase in incidence (101%) over 10 years (2009–2018). The prevalence of SLE is 24.7 per 100 thousand of the country’s population, lower than in other countries with a predominant Asian population or in comparison with Asian populations. A cohort of patients with SLE was represented by people of the Asian race (83.33%), Kazakhs (76.47%), and young people (33.85±10.58). The analysis revealed a delayed verification of the diagnosis of SLE (on average 4.5 (3; 12) years). Acute variants of the course of the disease with high disease activity according to SLEDAI-2K prevail. Common clinical manifestations of SLE are skin lesions, both acute and chronic (98%), joints (79.4%), damage to the nervous system (49%), hematological (54.9%) and immunological disorders (100%).