Clinical and Laboratory Predictors of the Effectiveness of Genetic Engineering Biological Therapy of Systemic Rheumatic Diseases in the Pediatric Population of the Kabardino-Balkarian Republic

Introduction. Systemic rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and periodic disease (PD) represent a major public health challenge. In recent years, a tendency towards increasing incidence of these pathologies, especially among the pediatric population, has been observed. Introducing genetically engineered biological therapy (GEBT) opens up new opportunities for the treatment of these diseases. Purpose. To study current trends in epidemiology and the effectiveness of the GEBT of systemic rheumatic diseases in the pediatric population of the Kabardino-Balkarian Republic to optimize medical care provision. Materials and methods. A retrospective analysis of statistical data on the incidence of systemic rheumatic diseases in the Kabardino-Balkarian Republic for the period from 2018 to 2023 and prospective clinical observation of 73 children with systemic rheumatic diseases receiving GEBT were performed. The treatment effectiveness was assessed every 3 months using activity indices (DAS28, SLEDAI, AIDAI), laboratory parameters (ESR, CRP), ultrasound and radiological data. Statistical processing of the results was performed in the SPSS 23.0 program. The obtained data were interpreted as reliable, and differences between the parameters were considered significant at p<0.05. Results. Over the period 2018–2023, there was an increase in the incidence of RA by 18.4% (p<0.05), SLE by 12.7% (p<0.05) and BE by 23.1% (p<0.01). The analysis of the effectiveness of GEBT demonstrated that the highest frequency of achieving remission was noted in the PD subgroup (78.5%), slightly lower values were recorded for RA (67.8%) and SLE (59.2%). In all subgroups, against the background of GEBT, a pronounced decrease in laboratory markers of inflammation, ESR and CRP, was recorded, most pronounced in PD. The correlation analysis of clinical and laboratory predictors and the effectiveness of GEBT showed that the presence of systemic manifestations (r= –0.47, p<0.05), high values of activity indices (r= –0.52, p<0.01) and ESR (r= –0.39, p<0.05) at the time of GEBT initiation were the factors that negatively affect the remission achievement. At the same time, the carriage of HLA-B27 in PD was associated with a better therapeutic response (r=0.64, p<0.01). Conclusion. At the present stage, in the pediatric population of the KBR, there is a clear tendency towards increasing in the incidence of the main systemic rheumatic diseases, i. e. RA, SLE and PD. Timely GEBT prescribing allows achieving remission in the vast majority of patients, especially in those with PD. The most significant predictors of the GEBT effectiveness are no previous basic therapy, low disease activity at the time of GEBT initiation, and HLA-B27 carriage in PD. The data obtained are important for optimizing the treatment and diagnostic tactics for systemic rheumatic diseases in children. © 2025 Elsevier B.V., All rights reserved.