СОВРЕМЕННЫЕ ВЗГЛЯДЫ НА ВОПРОСЫ ПАТОГЕНЕТИЧЕСКОЙ ТЕРАПИИ РЕВМАТОИДНОГО АРТРИТА

D. G. Rekalov; A. V. Kulynych; S. I. Svistun; E. V. Presnyakova

doi:10.14739/2310-1210.2013.6.20832

Authors

D. G. Rekalov Zaporozhye State Medical University,
A. V. Kulynych Zaporozhye State Medical University,
S. I. Svistun Zaporozhye State Medical University,
E. V. Presnyakova UE “Zaporizhzhia Regional Clinical Hospital” ZRC,

DOI:

https://doi.org/10.14739/2310-1210.2013.6.20832

Keywords:

early rheumatoid arthritis, biologic agents, disease - modifying antirheumatic therapy

Abstract

Development of the early rheumatoid arthritis (eRA) may occurs at any age (most often at age of 40-50 years). It is known that usually it is accompanied by severe disability. That is why early diagnostic of eRA and then selecting the modern method of treatment of this disease become extremely important.

The main therapeutic techniques aimed at reducing the eRA symptoms: pain and stiffness, providing an anti-inflammatory effect, preserving the ability of the patient's day to day functions, prevention of destructive processes. After active analysis of patient comorbidity (cardio - vascular disease, osteoporosis, gastropathy) an aggressive, fast-acting therapy eRA through the use of combination regimens disease-modifying antirheumatic drugs (DMARDS), extensive use of "anti-cytokine therapy," or biological agents (BA) and biosimilars (BS) should be started as quick as possible.

To evaluate the effectiveness of treatment must take into account the dynamics of changes in clinical parameters and markers of inflammation, as well as monitoring data of questioning patients about pain intensity (VAS), the overall assessment of disease activity (DAS28) and the degree of physical function violation (HAQ).

A brief review on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids (GCS) in patients with eRA. Reported data on the safety profile of NSAIDs and GCS, as well as data on the risk reduction of bone mineral density and the development of various low-energy fractures of the use of proton pump inhibitors (PPIs) in treatment of patients with RA. In view of these clinical studies, NSAIDs have failed to demonstrate the structural disease-modifying effects, so this group of drugs should be used only in combination with DMARD and GCS. The article presents a comparative analysis of various representatives from a number of GCS.

The article presents the survey of research of the need of rapid and effective suppression of inflammation with DMARDs, which contributes to the modification of the clinical course of the disease. The most effective was induction of long-term response in RA by methotrexate (MTX), while there is a high adherence to treatment, long-term tolerability and low cost treatment. Safe of the DMARD treatment requires careful clinical monitoring of the side effects. One of the most frequent adverse events in patients taking DMARDs is the liver damage, which requires the measurement of albumin and serum aminotransferase levels every 4-8 weeks, and the assessment of the overall analysis of blood, determination of serum creatinine.

TNF-α antagonists are recommended for the treatment of RA-preserving activity, despite adequate therapy attempts by other basic drugs, most often - MTX. TNF-α antagonists may be used in combination with other DMARDs.

The article describes aspects of the BS for treatment of RA, which show a significant improvement in long-term results and effectiveness. Highlights the key issues debatedinitial-and post-treatment of RA.

Conclusion. The modern strategy for the treatment of RA has recently undergone a major change with the introduction of BA and BS. The main goals of RA therapy are not only the reduction of inflammatory changes of the destructive processes but also achievement of prolonged and sustained remission and, in some cases, complete recovery. While achieving the expected results should not be accompanied by an increase of the number of undesirable side effects.

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