Keywords: Autoimmune disease; Exhaustion of cells; Human herpesvirus 6; Long-COVID; NK cells.

Pain in both peripheral and axial joints is a major symptom in patients with psoriaticarthritis (PsA) and axial spondyloarthritis (axSpA). Emerging evidence demonstrates pain mechanisms,beyond those related to inflammation or joint damage, based on aberrant processing of nociceptivestimuli peripherally as well as centrally. The Janus kinase/signal transducers and activators of transcrip-tion (JAK-STAT) signaling pathway has been implicated in the processing of pain beyond its role inmediating inflammation and inhibitors of this pathway approved for the treatment of axSpA and PsAhave been shown to alleviate a broad array of pain outcomes in both axial and peripheral joints.Areas covered: We review recent definitions and standardization of the nomenclature for categorizingchronic pain according to causality, assessment tools to evaluate nociplastic pain, the pathophysiologic roleof JAK-STAT signaling in nociplastic pain, evidence for the presence of nociplastic pain in axSpA and PsA,and the impact of JAK inhibitors (JAKi) on pain outcomes in clinical trials (PubMed: 01/01/2019-04/01-2024).Expert opinion: Nociplastic pain assessment has been confined almost entirely to the use of a limitednumber of questionnaires in cross-sectional studies of these diseases. Though effective for alleviatingpain, it is unclear if JAKi specifically impact nociplastic pain.ARTICLE HISTORYReceived 20 May 2024Accepted 30 August 2024KEYWORDSAnkylosing spondylitis; axialspondyloarthritis; nociplasticpain; janus kinases; psoriaticarthritis1. IntroductionPain is a key symptom of the inflammatory arthritis that may affectaxial and peripheral joints in patients with axSpA and PsA. Recentavailability of bDMARD and targeted synthetic DMARD (tsDMARD)agents targeting cytokines implicated in inflammation has led toa significantly beneficial impact on pain as well as other symptomsrelated to joint inflammation. However, remission of pain aftersuch treatment occurs in only 20–25% of patients, irrespective ofthe DMARD that is used. Moreover, evaluation of the severity ofand changes in inflammation using objective measures of inflam-mation, such as serum C-reactive protein (CRP) and magneticresonance imaging (MRI) parameters of joint inflammation, hasdemonstrated only limited correlation with assessments of painseverity and change with treatment, this being limited to patientswith short symptom duration and dissipating over time.Conversely, recent work in axSpA has demonstrated beneficialeffects of a specific bDMARD on pain in the apparent absence ofany objective features of inflammation [1].The recent introduction of JAKi for the treatment of PsA andaxSpA has further put the spotlight on our understanding ofmechanisms accounting for pain in these conditions because ofobservations demonstrating a rapid onset of significant pain reliefin clinical trials [2,3]. This has coincided with recent studies inanimal models suggesting a role for JAK-STAT signaling, andcytokines modulated by JAK signaling pathways, in peripheraland central processing of afferent pain signals [4,5]. There is alsoincreasing awareness that abnormalities of central and peripheralpain processing pathways, unrelated to abnormalities of neural ornon-neural tissues such as joints, may be important contributorsto the perception of pain in patients with axSpA and PsA.This manuscript aims to review the recent literature thatfocuses on a consensus-based mechanistic framework fordefining different categories of pain, outcome tools for theassessment of these different categories of pain, evidence forthe presence of pain in axSpA and PsA that may be unrelatedto inflammation or joint damage, the evidence supportinga role for JAK-STAT signaling in non-inflammatory pain, andwhat is known from clinical trials about the impact of treat-ment with JAKi on pain that may be unrelated to anti-inflammatory effects. The review will focus particularly onnociplastic pain, which is an emerging area of considerableinterest to clinicians because of its prevalence in patients withaxSpA and PsA, and the possibility that JAKi could havediverse mechanistic effects in ameliorating pain.2. Nomenclature of chronic pain and relevantoutcome tools2.1. Pain definitions and the international associationfor the study of pain frameworkIn 2020, the International Association for the Study of Pain(IASP) updated the general definition of pain for the first timeCONTACT Walter P. Maksymowych walter.maksymowych@ualberta.ca Department of Medicine, University of Alberta, 568 Heritage Medical ResearchBuilding, Edmonton, Alberta T6R 2G8, CanadaEXPERT REVIEW OF CLINICAL IMMUNOLOGY2025, VOL. 21, NO. 2, 137–152https://doi.org/10.1080/1744666X.2024.2400294© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

Keywords: Axial spondyloarthritis; Computed tomography; Deep learning; Diagnosis; Magnetic resonance imaging; Prognosis; Sacroiliac joint; Spine.

УДК: 612.014.484:012.015.1]-078.73-037-092.9

Abstract. Military personnel who have received combat injuries experience long-term consequences of severe injuries that have a significant impact on 
quality of life and sexual function. There is growing evidence that post-trau matic stress disorder, which develops secondary to injury, is associated with 
higher rates of erectile dysfunction, decreased sexual desire, and premature  ejaculation. Combat-related injuries may also have significant consequences for  male fertility, as they typically serve during their peak sexual activity years.

The aim of the work was to comparative analysis of the International Index  of Erectile Function and quality of life indicators in men with combat injuries 
and sexual dysfunction accompanied by chronic pelvic pain and premature  ejaculation, before and after treatment.
Methods. The study was based on the results of a questionnaire survey of  76 men aged 20–53 years, injured as a result of combat operations (mostly as a  result of polytraumatic injuries) before and after treatment using the Interna tional Index of Erectile Function-5 questionnaire and the SF-36 questionnaire  to assess the quality of life. After establishing the appropriate diagnoses, the patients were divided into two groups. Group 1 incluted patients with erectile  dysfunction of mixed genesis, accompanied by chronic pelvic pain, included  combat participants with endothelial dysfunction, metabolic syndrome, dyslipid emia, hypertension, coronary artery disease, late hypogonadism (n = 48); Group  2 incluted patients with erectile dysfunction of mixed genesis and premature  ejaculation combatants with endothelial dysfunction, metabolic syndrome, dyslipidemia, hypertension, coronary heart disease, late hypogonadism (n = 28).
Results. It was shown that the elimination of pelvic pain after successful  etiotropic therapy of patients in group 1, along with multifaceted treatment of 
ED (pathogenetic therapy), leads to a significant improvement in the indicators  of general health, role-physical functioning, role-emotional functioning, life  activity, mental health, and the absence of pain. Elimination of the cause of  erectile function through psychotherapy with potentiation of the effect by takng sildenafil leads to a significant increase in the average score of all MIEF-5  domains, and therefore an improvement in sexual function as a whole. After  treatment of patients in group 2, a significant increase in the average score of  the absence of pain from 84,9 to 95,1 is observed. The average score for vital  activity significantly increased from 63,9 to 70,2 (p < 0,05), and there was also  a trend towards improvement in the mental health domain from 68,1 to 74,3. 
Conclusions. The results of the study indicate a significant prevalence  of mixed forms of erectile dysfunction, accompanied by chronic pelvic pain or  premature ejaculation, which bothers men after suffering combat injuries. As  a result of the treatment of erectile dysfunction of mixed genesis with chronic  pelvic pain, indicators of general health, role-physical functioning, role-emo tional functioning, life activity, mental health, absence of pain sensation and  sexual function in general improve. After comprehensive treatment of men with  erectile dysfunction of mixed genesis and premature ejaculation, indicators of  pain sensation, life activity, satisfaction from sexual intercourse and sexual life  significantly improve, and there is also a tendency to improve mental health.
Key words: combat trauma, erectile dysfunction, quality of life, MIEF-5  questionnaire, SF-36 questionnaire.

УДК: 612.014.484:012.015.1]-078.73-037-092.9

Introduction. Priapismisafrequentpainfulerectionthatlastsmorethan4hoursandisnotcaused bysexualstimulation,occurswhenbloodisblockedinthepenisandcannotleaveit.Itisbelieved thattheincreaseinthefrequencyofpriapismdirectlydependsontheprevalenceofintracavernous injectionsofvasoactivesubstancesinthetreatmentoferectiledysfunction.
Aim. Toevaluatethepathogeneticfeaturesofthedevelopmentofpriapism,asoneoftheforms
ofsexualdysfunction,inmeninjuredasaresultofcombatoperations(combattrauma)andto
optimizetreatmentmethods.
Materials and methods. Thestudy included14priapismpatientswhowere treatedat the
urologyclinicin2022‑2024.Priapismasacomplicationdevelopedin2(4.4%)of45patientsafter
intracavernousinjectionof20μgofprostaglandinE1(PGE1)(group1),in1(10%)of10patientsafter
sequentialinjectionof20μgofPGE1and0,5mgofphentolamine(group2),in3(20%)of15patients
afterinjectionof2%solutionpapaverine(group3).In5patients,priapismoccurredagainstthe
backgroundofsystematicuseofanticoagulants(lowmolecularweightheparin)inthetreatmentof
severevascularpathology(phlebothrombosis,thrombophlebitis)(group4).Inanother3patients,
thecausethatledtopriapismwasnotfound,sotheidiopathicformwasestablished(group5).
Results. Itwasshownthatin3cases,thedurationofpriapisminpatientswithpsychogenicEDwas
insignificant,sinceallpatientswerewarnedaboutthepossibledevelopmentofpriapismbefore
theinjectionofthevasoactivedrugandrecommendedtoseekmedicalhelpimmediatelyincaseof
itsoccurrence.Threeoutofthreepatientswithapreviousdiagnosisofmixederectiledysfunction
(withanorganicvascularcomponent)failedtorestoreerectilefunctionaftershunting.Threeout
offourpatientsdiagnosedwithidiopathicpriapismreportedtheabsenceoferectionsduring
severalmonthsofpostoperativefollow‑up.Innocasewastherearecurrenceofpriapisminthe
postoperativeperiod.
Conclusions. TheobtaineddataallowustorecommendprostaglandinE1asthedrugofchoice
amongvasoactivesubstancesforintracavernoususeduetoitshighestsafety.Unilateraltranscaputal
punctureofthecavernousbody(Wintershunt)inpatientswithischemicpriapismmadeitpossible
toachievedetumescencein100%ofcaseswithoutsubsequentrecurrenceandrestoreerectile
functionin40%ofpatients.
Keywords: priapism, erectile dysfunction, combat trauma, treatment, vasoactive drugs