Leading Russian specialists discussed a wide range of issues related to attention deficit hyperactivity disorder (ADHD), as well as its comorbid syndromes at the Canonpharma Production satellite symposium — ADHD and Comorbid Syndromes. The event was held as part of the 3rd National Paediatric Neurology Congress with International Participation on March 20, 2026.

In Russia, tenecteplase, a third-generation thrombolytic agent that previously was known exclusively to cardiologists, became available for intravenous thrombolysis in ischemic stroke in 2026. While other countries have accumulated and summarized extensive experience in using this agent for the treatment of ischemic stroke in real-world clinical practice, there are currently only a few papers published in our country, demonstrating its therapeutic potential. This article describes two clinical cases of thrombolysis with the Russian tenecteplase (Nektelisa), which is officially approved for the treatment of ischemic stroke. In the first patient, thrombolysis performed in a CT room resulted in complete recanalization of the embolic middle cerebral artery (MCA) occlusion, which made it possible to avoid thromboextraction. In the second patient, tenecteplase was used as part of step-wise reperfusion therapy for atherosclerotic MCA occlusion prior to thromboextraction. This case was also interesting because antiplatelet therapy was escalated with tirofiban to prevent early reocclusion, followed by switching to a combination of aspirin and clopidogrel. The case discussion highlighted key randomized clinical trials evaluating tenecteplase in various clinical settings: in the standard and extended time windows, in patients with and without large cerebral artery occlusion. Both clinical cases demonstrated high efficacy and safety of tenecteplase in the treatment of stroke, consistent with international trial data.

Migraine is one of the most significant medical problems of our time, being the leading cause of disability and impaired quality of life in women of reproductive age. Rimegepant is an orally administered CGRP receptor antagonist with a unique dual-use concept, enabling both effective relief of acute attacks and long-term migraine prevention. To assess the efficacy, tolerability, and safety of rimegepant in women, a narrative literature review was conducted, including a systematic search of PubMed, Web of Science, Scopus, and eLIBRARY.RU. In the first stage, 412 publications were identified using titles and keywords. After an in-depth analysis of full-text versions, 138 studies were selected, containing data from randomized controlled trials, pharmacokinetic, longitudinal, and cohort studies, as well as systematic reviews and meta-analyses. Ninety-two articles were selected for qualitative analysis, and 27 articles were selected for a quantitative comparison of efficacy and safety indicators. The Introduction section utilized nine publications to substantiate the epidemiological and pathophysiological significance of the problem. Eighty-eight studies were excluded from the analysis due to failure to meet the inclusion criteria: lack of original data, duplicate samples, conference abstracts without full text, and studies outside the target population of women of reproductive age. The final review included 50 publications. The search period ranged from 2010 to 2016, with priority given to publications from the last five years. According to the analysis, rimegepant is highly effective for both the relief of attacks and the preventive treatment of episodic migraine, as well as a favorable safety profile across various periods of a woman’s life. The oral route of administration, rapid reversibility of the pharmacological action, and the absence of immunogenicity and risk of drug-induced headache open up new possibilities for the care of patients with comorbid pathology, those taking hormonal medications, and those during pregnancy and lactation.

Introduction. Cognitive impairment, reaching the level of dementia, is one of the leading causes of death and disability in many countries. According to international epidemiological studies, Alzheimer’s disease (AD) and its combination with cerebrovascular pathology account for 60–80% of all cases of dementia. Given the high prevalence and high cost of treatment, developing effective approaches to AD therapy is a critical clinical challenge.

Aim. To evaluate the clinical efficacy, safety, and tolerability of donepezil (Alzer H) in routine clinical practice in patients with Alzheimer’s disease (AD) and mild-to-moderate mixed dementia.

Materials and methods. The study was conducted as part of a non-interventional observational program in a group of 118 patients (49 men and 69 women) with AD and mild-to-moderate mixed dementia aged 74.2 ± 5.2 years and disease duration of 2.9 ± 3.2 years. Donepezil (Alzheimer’s disease) was administered orally at a dose of 10 mg once daily at the same time, regardless of food intake. The duration of therapy was 3 months. Treatment efficacy was assessed using the Mini-Mental State Examination (MMSE), the clock drawing test, Sandoz Clinical Assessment-Geriatric (SCAG) scale, and the (Clinical Global Impression of Change, CGI-C) scale after 3 months of therapy. All adverse events during treatment were recorded.

Results. Donepezil (Alzer-H) treatment resulted in a significant reduction in the severity of cognitive impairment, improvement in emotional and behavioral states, and overall neuropsychiatric status. Significant positive changes were observed on the MMSE scale, the clock drawing test, and the SCAG scale.

Conclusions. Donepezil (Alzer-H) demonstrated clinical efficacy, safety, and good tolerability in patients with mild to moderate AD and mixed dementia. The drug can be recommended for widespread use in clinical practice.

Cognitive impairment, ranging from mild cognitive impairment to dementia, is increasingly recognized as a potential complication of diabetes. The rising prevalence of diabetes, coupled with an aging population, may lead to a significant increase in the prevalence of cognitive impairment among individuals with diabetes. The link between diabetes and cognitive impairment may reflect the direct effects of hyperglycemia on the brain or the impact of diabetes-related comorbidities, such as hypertension, dyslipidemia, or hyperinsulinemia. There is evidence of the influence of diabetic processes on both neurodegenerative and vascular processes, which contributes to both cognitive impairments similar to Alzheimer’s disease, such as amnestic impairments, and cerebrovascular cognitive impairments characterized by impaired executive cognitive functions. Hyperglycemia, obesity, and insulin resistance can cause microvascular dysfunction in the brain, which is already present in adults with prediabetes, leading to structural abnormalities in the brain such as vascularized lacunes, cerebral microhemorrhages, perivascular spaces, global brain atrophy, and microinfarcts, and there is increasing evidence that this is a key factor in cognitive decline. In addition, insulin or diabetes-related by-products may affect the amyloid cascade, which is thought to be responsible for Alzheimer’s disease. Therefore, the potential mechanisms linking diabetes to cognitive impairment are classified as cerebrovascular and non-cerebrovascular. Optimizing the treatment of cardiovascular risk factors in people with prediabetes and diabetes could be a potentially important therapeutic opportunity. Drugs with antioxidant and antihypoxic activity are promising in this regard. A literature search was conducted in the PubMed/MEDLINE, eLibrary, Cochrane Library, and Google Scholar electronic databases for the period from 1989 to 2025. A total of 216 literature sources were evaluated, of which 90 were included in the review.

Introduction. Atrial fibrillation (AF) is increasingly diagnosed in young and middle-aged patients and may impair quality of life not only through physical symptoms but also through psycho-emotional distress, anxiety, sleep disturbances, and potential cognitive decline.

Aim. To assess the impact of stress on cognitive function, nocturnal sleep quality, and quality of life in young and middle-aged patients with AF.

Materials and methods. A cross-sectional cohort study was conducted. Eighty patients with AF aged 18–59 years who were followed at the Central Clinical Hospital RZD-Medicine from September 2025 to April 2026 were included. Patients were divided into two groups: 24 individuals with moderate/high stress levels and 56 individuals with low stress levels according to the Reeder Stress Scale. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Stroop Test. Anxiety was evaluated using the Beck Anxiety Inventory, depression using the Hamilton Depression Rating Scale, perceived stress using the Perceived Stress Scale (PSS-10), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and quality of life using the SF-36 questionnaire.

Results. Patients with moderate/high stress levels demonstrated a statistically significant increase in the completion time of the third part of the Stroop Test and in the T3–T2 difference. No significant differences were observed in MMSE or MoCA scores. The same group exhibited higher levels of anxiety, depressive symptoms, perceived stress, poorer sleep quality, greater daytime dysfunction, and lower scores in several quality-of-life domains.

Conclusions. Moderate/high stress levels in young and middle-aged patients with AF are associated with a less favorable psychophysiological status, poorer sleep quality, reduced quality of life, impaired executive functioning, and greater severity of anxiety and depressive symptoms.

Chronic non-specific low back pain (CNLBP) is an extremely common syndrome, which is one of the leading causes of seeking medical help and temporary disability in the world. Its pathophysiology is increasingly associated with central sensitization and the phenomenon of nociplastic pain. The aim of the article is to analyze current data on the pathophysiology of CNLBP, to review the role of pharmacotherapy and to substantiate the place of nimesulide in the context of a multidisciplinary approach based on current clinical recommendations and evidence-based medicine. The tactics of managing a patient with CNLBP should be based on the principles of evidence-based medicine and include: informing the patient about a favorable prognosis; returning to an active lifestyle; prescribing complex drug and non-drug treatment with proven efficacy and taking into account comorbidity. The chronic pain syndrome is based on neuroplastic changes in the central nervous system, which requires a transition from a purely biomechanical model to a biopsychosocial one. This leads to the choice of complex therapy for patients with CNLBP, combining medicinal and non-medicinal methods. Pharmacotherapy plays an important role today, especially at the pain relief to activate the patient stage. In this context, nimesulide, a selective COX-2 inhibitor with proven efficacy in CNLBP, demonstrates rapid onset of effect and a favorable gastrointestinal and cardiovascular safety profile. The clinical observation of the successful use of nimesulide as part of the complex therapy of CNLBP is presented. A modern strategy for the management of CNLBP should include mandatory patient education on the nature of pain and activation. Nimesulide is the drug of choice for relieving pain in this category of patients, allowing for a rapid clinically significant effect and commitment to rehabilitation.

Managing patients with acute low back pain is a pressing issue in modern medicine. A review of the literature in the electronic databases PubMed/MEDLINE, eLIBRARY.RU, Cochrane Library, Google Scholar for the period from 2016 to 2026 is presented. During the patient’s examination, it is necessary to exclude specific causes of pain, vertebrogenic radiculopathy, and central lumbar stenosis. If nonspecific (musculoskeletal) pain is diagnosed, which accounts for the majority of all low back pain-related consultations, the patient should be informed of the benign prognosis of the disease, the high probability of a rapid recovery, and the advisability of maintaining daily activities. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for acute nonspecific low back pain; they provide relatively rapid pain relief and improve the patient’s functional status. The use of a muscle relaxant can enhance the effect and reduce the duration of NSAID use, which is often associated with adverse effects. The efficacy and safety of the muscle relaxant thiocolchicoside (Tiplito), which has a long-standing positive clinical experience, for the treatment of acute back pain is discussed. Several placebo-controlled, randomized clinical trials have demonstrated the efficacy and good tolerability of thiocolchicoside for acute low back pain. Thiocolchicoside (Tiplito) is recommended for acute low back pain as intramuscular injections (4 mg 2 times a day) or oral tablets (capsules of 8 mg 2 times a day). The combination of thiocolchicoside with NSAIDs enhances analgesic efficacy, improves patients’ functional status, and reduces the duration of NSAID use. Common errors in the management of patients with acute low back pain and optimization of drug and non-drug therapy in clinical practice are discussed.

The relevance of chronic pain (CP) is determined by the difficulty of clinical objectification of central sensitization and neuroplastic changes. Existing scales and questionnaires reflect only subjective perception, while a number of instrumental diagnostic methods (functional magnetic resonance imaging, electroencephalography, quantitative sensory testing) have low specificity and methodological complexity with respect to CP analysis. Transcranial magnetic stimulation (TMS) is a method for objective and direct assessment of excitation and inhibition processes in the cerebral cortex, potentially underlying neuroplastic changes in CP. Aim: to systematize data on the use of TMS in various chronic pain syndromes. An analysis was conducted of studies employing single-pulse and paired-pulse transcranial magnetic stimulation (TMS) to assess corticospinal excitability (MEP, rMT, SICI, ICF, CSP, SAI). The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched using the following key queries: “transcranial magnetic stimulation and chronic pain”, “paired-pulse transcranial magnetic stimulation and chronic pain”, and “corticospinal excitability and chronic pain”. A total of 1,247 records were identified; after the removal of duplicates and irrelevant articles, 134 publications remained. Full-text analysis resulted in the selection of 29 studies reporting clinical data. In neuropathic pain, a decrease in intracortical inhibition (SICI) and interhemispheric asymmetry of excitability were revealed; in musculoskeletal pain, an imbalance of inhibition/facilitation (ratios of SICI, ICF, and CSP) was found; in migraine, a shortening of the cortical silent period (CSP) was observed; in fibromyalgia, an association of SICI with disease duration and anxiety, and ICF with pain intensity was shown; in complex regional pain syndrome, increased cortical excitability (increased rMT) was demonstrated. TMS parameters reflect key neuroplastic changes in CP and have potential as objective biomarkers for personalized diagnosis, therapy, and monitoring, but require protocol standardization and prospective validation for wide clinical implementation.

Introduction. Chronification of pain is an important medical and social problem. Approximately 30% of the world’s population suffers from chronic pain, and according to Russian data, 46% of patients in outpatient practice report chronic pain of various localizations.

Aim. To evaluate the possible effects and safety of a combination of Harpagophytum and Passiflora extracts in the form of herbal capsules for oral use in patients with chronic non-cancer pain syndrome.

Materials and methods. An open-label, non-comparative pilot clinical study included 11 patients with chronic non-specific (musculoskeletal) back and knee pain (mean age 54.7 years). The patients took a combination of Harpagophytum and Passiflora extracts in the form of herbal capsules for oral use (dietary supplement Harpagophen), 2 capsules twice daily for 14 days. The change of pain was assessed with the McGill Pain Questionnaire and the Visual Analogue Scale (VAS).

Results. During the administration of Harpagophen, a statistically significant (p = 0.04) reduction in the VAS score from 6.7 to 4.5 points (p = 0.04) and a positive change in pain quality according to the McGill Pain Questionnaire (reduction from 33 to 22 points) were observed. No adverse events were reported.

Conclusion. The results of this pilot study confirm the potential and safety of using a combination of Harpagophytum and Passiflora extracts in the form of herbal capsules for oral use in the complex therapy of chronic pain syndromes, which justifies the need for further research.

Depressive disorders represent a significant global public health burden and are a leading cause of morbidity and mortality. Transcranial magnetic stimulation is a non-invasive brain stimulation technique used to treat a wide range of neurological disorders, including depression. This method involves applying a magnetic field to specific areas of the brain through the skull in order to change the excitability of neurons. In transcranial magnetic stimulation, magnetic pulses of various shapes and frequencies are applied to specific regions of the brain to detect changes in excitability. Major depressive disorder was the first psychiatric disorder for which transcranial magnetic stimulation received approval from the U.S. Food and Drug Administration (FDA). This review presents the history of the method, the basic principles of TMS, and the various protocols used for applying TMS to patients with depressive disorders. Approved transcranial magnetic stimulation protocols include either low-frequency stimulation of the right dorsolateral prefrontal cortex or high-frequency stimulation of the left dorsolateral prefrontal cortex, or a combination of both. This review examines some of the key mechanisms of action of transcranial magnetic stimulation on depressive symptoms. This review presents the results of meta-analyses and randomized controlled trials published in recent years to evaluate the efficacy, safety, and clinical applications of transcranial magnetic stimulation in people with depression.

The use of transcranial magnetic stimulation as an effective and well-tolerated treatment in adolescents and elderly patients with depression is specifically discussed, particularly when side effects or comorbidities limit medication therapy. It is also shown that transcranial magnetic stimulation can be used in patients with depressive disorders and various comorbidities. Search for literature sources was carried out in electronic databases PubMed/MEDLINE, eLIBRARY.RU, Cochrane Library, Google Scholar for the period from 1996 to 2025. 126 sources of literature were evaluated, of which 94 sources of literature were included in the review.

Introduction. Late-life depression is one of the main causes of the burden of mental illness in modern society, leading to a reduction in healthy life expectancy and increased costs of care for those affected. Treatment of late-life depression presents significant challenges, making the development of additional methods to improve its effectiveness increasingly important. Currently, transcranial electrical stimulation is a non-invasive brain stimulation method, being actively studied both as a standalone therapy for mental disorders and in combination with psychopharmacological medications.

Aim. To evaluate the effectiveness of using transcranial direct current stimulation (tDCS) as an adjunct to standard treatment in patients with late-life depression.

Materials and methods. Cohort – 52 hospitalized patients 60 years and older with a current depressive episode according to ICD-10: depressive episode (F32.0) – 7.7%, depressive phase within recurrent depressive disorder (F33.0) – 92.3%. Patients were randomly assigned to two groups. The group 1 (25 people) received high-resolution tDCS (direct current electrostimulation syndrome) along with antidepressant therapy. The group 2 (27 people) received standard antidepressant therapy. A comparative evaluation of the effectiveness of a 28-day course of therapy in the groups was conducted. Methods – clinical, psychopathological, psychometric, neurophysiological, statistical.

Results. The effectiveness of treatment was significantly higher in the group of patients with complex therapy with antidepressants in combination with tDCS compared with antidepressant monotherapy: the average total score on the HAMD-17 scale decreased by 65.63% and 55.23%, the proportion of respondents was 100% and 62.9%, respectively (p < 0.05). In patients with complex therapy There was a more pronounced improvement in cognitive functioning.

Conclusion. Treatment efficacy was significantly higher in the group 1: the average total HAMD-17 score decreased by 65.63% and 55.23%, with the responder rates being 100% and 62.9%, respectively (p<0.05). The reduction of anxiety disorders by the end of the course of therapy was 65.07 and 57.30%, respectively (p < 0.05), and the average degree of improvement in cognitive functioning (on the MMSE scale) was 7.26 and 3.29%, respectively (p < 0.05).

Restless Legs syndrome (RLS) occurs in about 3% of adults worldwide. RLS is still poorly diagnosed including due to the lack of screening tools based on verbal descriptors. A literature review was conducted using the eLibrary.ru, CyberLeninka, PubMed, Scopus, and Google Scholar databases, based on the keywords “restless legs syndrome”, “pathogenesis”, “diagnosis”, and “reatment”. The search covered a 25-year period. The gathered information was analyzed, systematized, and presented in the following sections: iron deficiency and RLS, genetic predisposition to RLS, the dopaminergic system and RLS, other risk factors and associated conditions, the clinical presentation of RLS, diagnostic criteria for RLS, and RLS treatment. RLS is commonly associated with iron deficiency. There is evidence of a genetic predisposition to RLS. Dopaminergic pathology in RLS is confirmed by the effectiveness of dopaminergic treatment, however, it can cause the phenomenon of augmentation – iatrogenic deterioration, which is characterized by an earlier onset of symptoms in the afternoon than before treatment, the spread of symptoms to the upper extremities and a decrease in the latency period before symptoms appear during periods of rest. Pharmacotherapy (high evidence strength) includes: gabapentin, gabapentin enacarbil, pregabalin, intravenous iron carboxymaltose. Conditionally recommended: intravenous low-molecular-weight iron dextran, ferumoxytol, iron sulfate, dipyridamole, delayed-release oxycodone or other opioids, peroneal nerve stimulation. Drugs that should not be prescribed as standard treatment: levodopa, pramipexole, transdermal rotigotine, ropinirole (can be used to treat RLS in patients who attach more importance to reducing RLS with short-term use and less importance to side effects with prolonged use (especially augmentation)).

Parkinson’s disease is a progressive neurodegenerative disorder that involves various brain structures and the peripheral autonomic nervous system, manifesting with a wide range of motor and non-motor symptoms. As the disease advances, the efficacy of levodopa in controlling motor disturbances inevitably declines, which is accompanied by the development of motor fluctuations and levodopa-induced dyskinesias. At advanced stages of Parkinson’s disease, the severity and diversity of non-motor manifestations also increase, the most common of which are pain (65–74%), fatigue (64–65%), sleep disturbances (62–63%), constipation (48%), as well as depression and apathy (39–43%). Motor fluctuations, dyskinesias, and non-motor symptoms collectively significantly impair patients’ quality of life and require timely treatment adjustment. Xadago (safinamide) is the only MAO-B inhibitor with a dual mechanism of action, combining a dopaminergic effect with a unique non-dopaminergic (antiglutamatergic) component. This article reviews the pharmacological profile of safinamide, its differences from other MAO-B inhibitors, and the results of randomized clinical trials confirming its efficacy and safety. In the 016, SETTLE, and XINDI studies, safinamide significantly increased ON-time without disabling dyskinesia and reduced OFF-time by an average of 1 hour. Furthermore, safinamide demonstrated efficacy in addressing non-motor symptoms: in the SAFINNOMOTOR study, a 38.5% reduction in the total Non-Motor Symptoms Scale (NMSS) score, a 43.6% decrease in pain intensity, as well as improvements in mood, sleep, and quality of life were observed.

Neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory diseases of the central nervous system. B-lymphocytes play leading role in their pathogenesis in most cases. СD20 surface antigen is one of the B-lymphocytes makers. There is extensive world experience with chimeric monoclonal anti-CD20 antibody rituximab off-label using for NMOSD exacerbations prevention. It has been included in published international and Russian algorithms for NMOSD treatment along with other approved medications. Divozilimab is recombinant humanized anti-CD20 monoclonal antibody with a modified glycosylation pattern of Fc-fragment which is approved in Russian Federation for the treatment of multiple sclerosis, systemic scleroderma and also for NMOSD (September 2025). The publication is intended to present the results of the Russian Expert Councils work in September 2025 and February 2026. According to the analysis of publications on anti-CD20 NMOSD therapy, the 6-month results of divozilimab study BCD-132-6/AQUARELLE (NCT05730699) and data of additional subanalysis experts agreed the profiles of NMOSD patients for divozilimab therapy, time to full therapeutic effect and monitoring plan during treatment with divozilimab. Experts supplemented the algorithm for initial prescription and switching of medications for prevention of NMOSD attacks in patients with AQP4-IgG aged 18 years and older, agreed on the algorithm for the administration of medications for prevention of NMOSD attack in patients without AQP4-IgG aged 18 years and older, determined positions of divozilimab in both algorithms. According to experts opinion divozilimab appears as promising treatment option in NMOSD. Analysis of divozilimab effectiveness and safety long-term results in BCD-132-6/AQUARELLE study and real-world practice will be important steps toward clarifying and potentially extending patient profiles.

Autoimmune disorders are common clinical conditions that result from an abnormal immune response to the body’s own structures. Most existing immunomodulatory drugs for multiple sclerosis (MS) therapy are capable of suppressing autoimmune reactions as long as they are used, but they do not target autoreactive immunological memory and cannot disable the underlying mechanisms to induce remission without therapy. Over the past decade, there has been an increased interest in highly effective immune reconstruction therapy (IRT), which can transiently or persistently provoke the immune system resetting. Cladribine (2-chloro-deoxyadenosine) in tablets belongs to the group of IRT drugs for relapsing multiple sclerosis (RMS), which therapy consists of two short courses of treatment during the 1st and 2nd year. Most patients achieve sustained efficacy with the use of cladribine, but a small proportion of patients may experience new disease activity that requires the treating physician to make a decision regarding a previously chosen treatment strategy. Since cladribine tablets were approved by the European Union, USA and Russia more than 5 years ago, the number of publications devoted to the analysis of real-world practice has been steadily increasing. The purpose of this publication is to present the results of Expert Council conducted in February 2026. The participants of the expert council developed further recommendations for the administration of the drug to therapeutically naive patients with relapsing-remitting MS, in secondary progressive MS with exacerbations, algorithms for managing patients with RMS with disease activity reactivation after the initial 2 courses of therapy with cladribine and subsequent follow-up, and discussed the profiles of patients in whom switching to cladribine tablets is considered as an option that reduces the risks of prolonged immunosuppression.

Introduction. Therapy aimed at eliminating CD20-positive B cells is considered one of the most significant advances in the treatment of multiple sclerosis. Divozilimab is a humanized anti-CD20 monoclonal antibody lacking fucose in its Fc fragment, which enhances its effector properties.

Aim. Тo analyze the efficacy and tolerability of divozilimab in patients with secondary progressive multiple sclerosis with exacerbations in real-world clinical practice.

Materials and methods. The prospective observational study included 20 patients with secondary progressive multiple sclerosis with exacerbations (55% women, median age 53.5 years) who received divozilimab for 12–24 months. The annualized relapse rate, MRI activity (T1 gadolinium-enhancing lesions, new T2 lesions), EDSS dynamics, the proportion of patients achieving NEDA-3, safety profile, and lymphocyte levels were assessed.

Results. Over 12 months, the annualized relapse rate decreased from 0.9 to 0.05 (p < 0.01); the proportion of relapse-free patients increased from 10% to 90%. At 12 months, 95% of patients had no gadolinium-enhancing lesions. The median EDSS remained stable at 4.0 points, with a tendency to decrease to 3.5 points at 24 months. NEDA-3 was achieved in 85% of patients. Infusion reactions were observed in 25% of patients (mostly mild, during the first administration). No serious adverse events were reported.

Conclusion. Divozilimab demonstrates pronounced suppression of inflammatory activity and a favorable safety profile in patients with secondary progressive multiple sclerosis with exacerbations, justifying its use in this clinical population.

Introduction. Joint inflammation in rheumatoid arthritis (RA) is accompanied by erosive and destructive changes, decreased bone mineral density (BMD), and impaired joint function.

Aim. To study the rate of radiographic progression (RP) in patients with RA, taking into account BMD, comorbidities, and anti-inflammatory therapy during long-term follow-up.

Materials and methods. A prospective, multi-year cohort study involving 151 women with RA, aged 53.9 ± 9.2 years. Followup was 9.7 ± 1.7 years. A dynamic clinical, laboratory, and radiographic examination was performed, analyzing changes in the Steinbrocker RA stage, Sharp erosion score, BMD at L1-L4, and in the proximal femur (PF).

Results. Slow RP (SRP) was detected in 63 (42%) patients, and rapid RP (RP) – in 32 (21%) patients. The age of patients with SRP was younger, including at the onset of RA, the duration of RA and the Sharp score were higher, the MIC in the POB and the methotrexate dose were lower. DAS28, positivity and levels of RF, anti-CCP, CRP, MIC L1-L4 in the SRP and SRP groups were comparable. Patients with SRP more often received glucocorticoids (GC), the duration of therapy, daily and cumulative dose of GC were higher (p < 0.0001). In the SRP group, the number of patients with coronary artery disease, chronic heart failure, and chronic kidney disease increased. The incidence of fractures in the MRP group increased from 17.4% to 47.6% (p < 0.001) versus 31.2% to 56.2% (p < 0.04) in the BRP group. The incidence of osteoporosis remained unchanged between the groups. Total joint replacement (TJR) was required in 34.3% of patients with MRP versus 7.9% with MRP (p = 0.006).

Conclusions. TJR was detected in patients with RA duration of more than 5 years receiving GC therapy; it is associated with decreased BMD, fractures, decreased quality of life, and the need for total joint replacement.

Treatment of late-stage rheumatoid arthritis (RA) in elderly patients presents known difficulties, which are associated with insufficient control of inflammation, the addition of extra-articular manifestations of the disease, the development of its complications, the presence of comorbidity, frequent intolerance to basic drugs and the potential toxicity of symptomatic agents. A clinical case of an elderly patient with a 20-year history of RA is presented. The disease was characterized by a progressive course, the ineffectiveness of synthetic basic anti-inflammatory drugs, the development of extra-articular manifestations (Sjogren's syndrome, anemia of chronic inflammation), secondary arthrosis of the joints of the lower extremities, osteoporosis with compression fractures of the vertebral bodies, probable AA-amyloidosis of the kidneys with chronic kidney disease, sarcopenia. The comorbid background included type 2 diabetes mellitus, arterial hypertension, ischemic stroke, non-alcoholic fatty liver disease, and dyslipidemia. After careful screening, tocilizumab therapy was initiated in subcutaneous form of 162 mg weekly. After 4 weeks, there was a decrease in morning stiffness, a decrease in the number of painful and swollen joints. By the 12^th week, relief of synovitis, normalization of C-reactive protein levels and erythrocyte sedimentation rate, increased hemoglobin, decreased proteinuria, and stabilization of kidney function were recorded. The DAS28 index dropped from 7.1 to 2.6. Prednisone was completely eliminated by week 20. Currently, tocilizumab therapy lasts 7 months, the drug is well tolerated, and no infectious complications, cytopenic or other adverse reactions have been reported. The use of a tocilizumab biosimilar in an elderly patient with long-term severe RA, multiple complications and comorbidity made it possible to achieve clinical and laboratory remission, stop anemia of chronic inflammation, reduce proteinuria, eliminate glucocorticoids and significantly improve the quality of life. The presented case substantiates the expediency of using IL-6 receptor inhibitors (including subcutaneous biosimilars) in patients of the older age group with a complicated course of RA.

Monocyte chemotactic protein-1 (MCP-1), also known as C-C motif chemokine ligand 2 (CCL2), plays a key role in regulating inflammation in various pathologies. It is directly or indirectly implicated in the pathogenesis of oncologic and pulmonary diseases, neuroinflammatory, cardiovascular, and skin diseases. Its role as a biomarker of disease severity has been proven. The role of this chemokine in the pathogenesis of immune-mediated inflammatory rheumatic diseases remains insufficiently studied and is of considerable scientific interest. The aim of this literature review was to analyze scientific data on the pathogenetic role of MCP-1 in rheumatoid arthritis (RA) and the prospects for its use in clinical practice. A search for scientific publications was performed in the electronic databases PubMed, Google Scholar, and eLIBRARY.RU, published in Russian and English before February 2026. This review of the scientific literature clarified the role of MCP-1 in the pathogenesis of RA and highlighted one of the most pressing areas of scientific research: the development of new drugs (antagonists of the receptor of this chemokine, CCR2). MCP-1 has been shown to play a key role in enhancing the inflammatory cascade and is closely associated with chronic, uncontrolled inflammation. MCP-1 exerts its biological effects on migration, infiltration, and differentiation of immune cells by binding to its receptor, CCR2. The MCP-1 (CCL2)/CCR2 axis is a central inflammatory mechanism that attracts monocytes to the site of inflammation. Currently, proposed CCR2 antagonist drugs are not sufficiently effective, and extrapolation of experimental results in animal models does not justify clinical trials. Nevertheless, the development of new CCR2 antagonists and/or their combination with other immunomodulators may be a promising strategy for improving the effectiveness of RA treatment.

Introduction. Sarcopenic obesity (SO) is a pathological condition characterized by the combination of sarcopenia and a high percentage of body fat mass, as determined by instrumental assessment of body composition. The diagnosis of SO in patients with rheumatoid arthritis (RA) is difficult due to the low informativeness of muscle strength assessment tests and the limited availability of body composition analysis by DXA.

Aim. To evaluate the possibilities of ultrasound examination of fat and muscle tissue of the lower limbs for the diagnosis of SO in women with RA.

Materials and methods. 52 women with RA (mean age 56.9 ± 8.2 years) were included. A full-body DXA scan was performed. The diagnosis of SO was based on a combination of appendicular muscle mass index < 5.5 kg/m² and total fat ≥ 35%. Ultrasound was used to measure the thickness of subcutaneous fat (TSF-AT) and muscles of the anterior thigh (TM-AT), the index of TSF-AT/TM-AT, the pennation angle of the medial head of the gastrocnemius muscle (PA-MHGM) and the thickness of subcutaneous fat of the calf (TSF-C).

Results. SO was diagnosed in 13 (25.0%) women. Significant rank correlations were found between SO and TSF-AT (τ = 0.24), TM-AT (τ = –0.33), and the index TSF-AT/TM-AT (τ = 0.34), whereas no associations were observed with the PA-MHGM and TSF-C. ROC-analysis showed that the index of TSF-AT/TM-AT had the best area under the curve (AUC) for the sensitivity-specificity ratio for diagnosis of SO (AUC = 0.777, p < 0.001). At a cut-off point of > 1.02, sensitivity and specificity were 53.9% and 84.6%, respectively.

Conclusion. The value of TSF-AT/TM-AT > 1.02 can be considered as a potential diagnostic marker of SO in patients with RA. In combination with measuring the strength and physical performance of skeletal muscles, this approach provides an accessible, radiation-free diagnostic method for SO in routine clinical practice.

Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatic diseases affecting older adults. The aim of this review was to analyze current concepts of the immunopathogenesis of PMR and the possibilities of pathogenetic therapy for this disease. A literature search was conducted in the PubMed, Scopus, Web of Science, eLIBRARY.RU and Google Scholar databases using the following keywords: “polymyalgia rheumatica”, “immunopathogenesis”, “immunosenescence”, “methotrexate”, “biologic therapy”, “IL-6 inhibitors”, “IL-17 inhibitors”, “targeted therapy”, “tocilizumab”, “sarilumab”, “olokizumab”, “tofacitinib”, “baricitinib”, and their Russian-language equivalents. A total of 110 publications were initially identified. Following full-text assessment, 24 articles were excluded due to lack of relevance to the review topic, insufficient informativeness, or the absence of significant data regarding the immunopathogenesis and treatment of PMR. A total of 86 publications were included in the qualitative analysis, comprising randomized controlled trials, cohort studies, clinical observations, systematic reviews, and basic research studies. Twelve publications focusing on the immunopathology of PMR were used for preparation of the Introduction section. The analysis demonstrated that immunosenescence, activation of innate and adaptive immunity, disturbances in Tand B-cell immune responses, and dysregulation of the cytokine network, with a central role of interleukin-6, are key contributors to the pathogenesis of PMR. The most convincing evidence currently supports the use of interleukin-6 and interleukin-17 inhibitors, whose efficacy has been confirmed in randomized clinical trials. Expanding knowledge of the mechanisms underlying the disease contributes to the development of personalized treatment approaches for patients with PMR and to the optimization of long-term disease control.

Introduction. Low testosterone levels are common in men with rheumatoid arthritis (RA). Patients with RA and hypogonadism have higher levels, reflecting systemic inflammation. Both RA and hypogonadism can negatively impact quality of life.

Aim. To assess the impact of low testosterone levels on quality of life in men with RA.

Materials and methods. A cross-sectional study of 73 men diagnosed with RA was conducted. All patients had their total blood testosterone levels measured and were administered the HAQ, EQ-5D, and HADS questionnaires. A cross-sectional comparison of quantitative and qualitative parameters was performed between normal and low (≤12.0 nmol/L) total blood testosterone levels.

Results. Patients with hypogonadism and RA were characterized by lower quality of life indicators, which was reflected in the results of the HAQ questionnaires (1.59 ± 0.88 vs. 1.09 ± 0.87; p = 0.036), EQ-5D (0.52 [-0.01; 0.64] vs. 0.62 [0.52; 0.69]; p = 0.048), as well as the patient’s assessment of the general condition using VAS (70.0 [60.0; 80.0] vs. 60.0 [55.0; 70.0]; p = 0.039). The results of the HADS questionnaire were comparable in the studied subgroups. In the correlation analysis, the HAQ score correlated with RA activity according to DAS28CRP (r = 0.58; p < 0.001), ESR (ρ = 0.51; p < 0.001) and CRP (ρ = 0.55; p < 0.001), as well as the class of functional impairment (ρ = 0.26; p = 0.025), total testosterone (ρ = -0.3; p = 0.009) and hemoglobin (ρ = -0.48; p < 0.001). High RA activity (DAS28CRP ≥ 5.1), but not the presence of hypogonadism, as well as factors related to age and body weight, significantly increased the likelihood of having more negative results according to the HAQ questionnaire: OR 17.5; 95% CI 4.5–68.1 (p < 0.001) for HAQ ≥ 1.0 and OR 18.12; 95% CI 1.03–319.23 (p = 0.048) for HAQ ≥ 2.0.

Conclusion. Patients with RA and hypogonadism have a lower quality of life, which is due to the influence of inflammatory activity.