PHARMACOTHERAPY OF RHEUMATOID ARTHRITIS


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The article considers the modern strategy of pharmacotherapy of rheumatoid arthritis (RA), which is based on the use of standard disease-modifying anti-rheumatic drugs, primarily methotrexate and glucocorticoids, as weft as timely application of a wide range of innovative genetic engineering biological, agents - monoclonal antibodies and recombinant proteins that block the activity of «pro-inffammatory» cytokines and/or pathological activation of T- and B-fymphocytes involved in the development of immunoinflammatory process. Particular attention is paid to the new EULAR recommendations on the strategy and tactics of treatment of early arthritis, which can potentially transform into a reliable RA, being the first manifestation of a wide range of rheumatic diseases, «self-limiting» arthritis or arthritis, which for a long time remains undifferentiated. The importance of developing new approaches to the prevention of RA in high-risk groups is emphasized, and they can lead to radical improvement in prognosis.

Full Text

Restricted Access

About the authors

Yevgeny L. Nasonov

academician of RAS, MD, professor, president of Russian Association of Rheumatologists, chief freelance specialist in rheumatology of Ministry of Health of Russia, V.A. Nasonova Research Institute of Rheumatology 115522, Moscow, 34A Kashirskoe shosse

References

  1. Насонов Е.Л., Каратеев Д.Е., Балабанова Р.М. Ревматоидный артрит. В кн.: «Ревматология. Национальное руководство» под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008. С. 290-331. [Nasonov Ye.L., Karateev D.Ye., Balabanova R.M. Rheumatoid arthritis. In the book: «Rheumatology. National leadership» edited by Ye.L. Nasonov, V.A. Nasonova. Moscow: GEOTAR-Media, 2008. P. 290-331 (in Russ.)]
  2. Smolen J.S., Aletaha D., McInnes I.B. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-38.
  3. Генно-инженерные биологические препараты в лечении ревматоидного артрита. Под ред. Е.Л. Насонова. М.: ИМА-Пресс, 2013. [Genetically engineered biological drugs in the treatment of rheumatoid arthritis. Edited by Ye.L. Nasonov. Moscow: IMA-Press, 2013 (in Russ.)]
  4. Venuturupalli S. Immune mechanisms and novel targets in rheumatoid arthritis. Immunol. Allergy Clin. North Am. 2017;37(2):301-13.
  5. Smolen J.S., Aletaha D. Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. Nat. Rev. Rheumatol. 2015;11(5):276-89.
  6. Smolen J.S., Aletaha D., Bijsma J.W.J., Breedveld F.C., Boumpas D., Burmester G., Combe B., Cutolo M., de Wit M., Dougados M., Emery P., Gibofsky A., Gomez-Reino J.J., Haraoui B., Kalden J., Keystone E.C., Kvien T.K., McInnes I., Martin-Mola E., Montecucco C., Schoels M., van der Heijde D.; T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann. Rheum. Dis. 2010;69:631-7.
  7. Smolen J.S., Landewé R., Breedveld F.C., Buch M., Burmester G., Dougados M., Emery P., Gaujoux-Viala C., Gossec L., Nam J., Ramiro S., Winthrop K., de Wit M., Aletaha D., Betteridge N., Bijlsma J.W., Boers M., Buttgereit F., Combe B., Cutolo M., Damjanov N., Hazes J.M., Kouloumas M., Kvien T.K., Mariette X., Pavelka K., van Riel P.L., Rubbert-Roth A., Scholte-Voshaar M., Scott D.L., Sokka-Isler T., Wong J.B., van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann. Rheum. Dis. 2014;73:492-509.
  8. Smolen J.S., Landewé R., Bijlsma J., Burmester G., Chatzidionysiou K., Dougados M., Nam J., Ramiro S., Voshaar M., van Vollenhoven R., Aletaha D., Aringer M., Boers M., Buckley C.D., Buttgereit F., Bykerk V., Cardiel M., Combe B., Cutolo M., van Eijk-Hustings Y., Emery P., Finckh A., Gabay C., Gomez-Reino J., Gossec L., Gottenberg J.E., Hazes J.M.W., Huizinga T., Jani M., Karateev D., Kouloumas M., Kvien T., Li Z., Mariette X., McInnes I., Mysler E., Nash P., Pavelka K., Poâr G., Richez C., van Riel P., Rubbert-Roth A., Saag K., da Silva J., Stamm T., Takeuchi T., Westhovens R., de Wit M., van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann. Rheum. Dis. 2017;76(6):960-77.
  9. Singh J.A., Saag K.G., Bridges S.L. Jr, Akl E.A., Bannuru R.R., Sullivan M.C., Vaysbrot E., McNaughton C., Osani M., Shmerling R.H., Curtis J.R., Furst D.E., Parks D., Kavanaugh A., O'Dell J., King C., Leong A., Matteson E.L., Schousboe J.T., Drevlow B., Ginsberg S., Grober J., St. Clair E.W., Tindall E., Miller A.S., McAlindon T. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheum. 2016;68:1-26.
  10. Насонов Е.Л., Мазуров В.И., Каратеев Д.Е. и др. Проект рекомендаций по лечению ревматоидного артрита Общероссийской общественной организации «Ассоциация ревматологов России» - 2014 (часть 1). Научно-практическая ревматология. 2014;52:477-94. [Nasonov Ye.L., Mazurov V.I., Karateev D.E. Draft recommendations for the treatment of rheumatoid arthritis of the Russian public organization «Association of rheumatologists of Russia" -2014 (part 1). Scientific-practical rheumatology. 2014;52:477-94 (in Russ.)]
  11. Ревматоидный артрит. В кн.: «Ревматология. Российские клинические рекомендации». Под ред. Е.Л. Насонова. М.: ГЭОТАР-Медиа, 2017. С. 17-57. [Rheumatoid arthritis. In the book: «Rheumatology. Russian clinical recommendations.» Edited by Ye.L. Nasonov. Moscow: GEOTAR-Media, 2017. P. 17-57 (in Russ.)]
  12. Насонов Е.Л., Каратеев Д.Е., Чичасова Н.В. Рекомендации EULAR по лечению ревматоидного артрита - 2013: общая характеристика и дискуссионные проблемы. Научно-практическая ревматология. 2013;51:609-22. [Nasonov Ye.L., Karateev D.Ye., Chichasova N.V. EULAR recommendations for rheumatoid arthritis treatment - 2013: General overview and discussion of the problem. Scientific-practical rheumatology. 2013;51:609-22 (in Russ.)]
  13. Combe B., Landewe R., Daien C.I., Hua C., Aletaha D., Âlvaro-Gracia J.M., Bakkers M., Brodin N., Burmester G.R., Codreanu C., Conway R., Dougados M., Emery P., Ferraccioli G., Fonseca J., Raza K., Silva-Fernandez L., Smolen J.S., Skingle D., Szekanecz Z., Kvien T.K., van der Helm-van Mil A., van Vollenhoven R. 2016 update of the EULAR recommendations for the management of early arthritis. Ann. Rheuml. Dis. 2017;76(6):948-59.
  14. Machado P., Castrejon I., Katchamart W., Koevoets R., Kuriya B., Schoels M., Silva-Fernandez L., Thevissen K., Vercoutere W., Villeneuve E., Aletaha D., Carmona L., Landewé R., van der Heijde D., Bijlsma J.W., Bykerk V., Canhão H., Catrina A., Durez P., Edwards C.J., Mjaavatten M.D., Leeb B.F., Losada B., Martin-Mola E.M., Martinez-Osuna P., Montecucco C., Müller-Ladner U., 0stergaard M., Sheane B., Xavier R.M., Zochling J., Bombardier C. Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann. Rheum. Dis. 2011;70:15-24.
  15. Aletaha D., Neogi T., Silman A.J., Funovits J., Felson D.T., Bingham C.O. 3rd, Birnbaum N.S., Burmester G.R., Bykerk V.P., Cohen M.D., Combe B., Costenbader K.H., Dougados M., Emery P., Ferraccioli G., Hazes J.M., Hobbs K., Huizinga T.W., Kavanaugh A., Kay J., Kvien T.K., Laing T., Mease P., Ménard H.A., Moreland L.W., Naden R.L., Pincus T., Smolen J.S., Stanislawska-Biernat E., Symmons D., Tak P.P., Upchurch K.S., Vencovsky J., Wolfe F., Hawker G. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann. Rheum. Dis. 2010;69:1580-8.
  16. Насонов Е.Л. Метотрексат при ревматоидном артрите - 2015: новые факты и идеи. Научно-практическая ревматология. 2015;53:421-33. [Nasonov Ye.L. Methotrexate in rheumatoid arthritis - 2015: new facts and ideas. Scientific-practical rheumatology. 2015;53:421-33 (in Russ.)]
  17. Насонов Е.Л., Каратеев Д.Е., Чичасова Н.В. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013): место метотрексата. Научно-практическая ревматология. 2014;52:8-26. [Nasonov Ye.L., Karateev D.Ye., Chichasova N.V. New recommendations for the treatment of rheumatoid arthritis (EULAR, 2013): the place of methotrexate. Scientific-practical rheumatology. 2014;52:8-26 (in Russ.)]
  18. Bello A.E., Perkins E.L., Jay R., Efthimiou P. Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis. Open Access Rheumatol. 2017;9:67-79.
  19. Насонов Е.Л., Яхно Н.Н., Каратеев А.Е., Алексеева Л.И., Баринов А.Н., Барулин А.Е., Давыдов О.С., Данилов А.Б., Журавлева М.В., Заводовский Б.В., Копенкин С.С., Кукушкин М.Л., Парфенов В.А., Страхов М.А., Тюрин В.П., Чичасова Н.В., Чорбинская С.А. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно-практическая ревматология. 2016;54:247-65. [Nasonov Ye.L., Yakhno N.N., Karateev A.Ye., Alekseeva L.I., Barinov A.N., Barulin A.Ye., Davydov O.S., Danilov A.B., Zhuravleva M.V., Zavodovsky B.P., Kopenkin S.S., Kukushkin M.L., Parfenov V.A., Strakhov M.A., Tyurin V.P., Chichasova N.V., Chorbinskaya S.A. General principles of treatment of musculoskeletal pain: a multidisciplinary consensus. Scientific-practical rheumatology. 2016;54:247-65 (in Russ.)]
  20. Насонов Е.Л. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013) - место глюкокортикоидов. Научно-практическая ревматология. 2015;53:238-50. [Nasonov Ye.L. New guidelines for treatment of rheumatoid arthritis (EULAR, 2013) - the place of glucocorticoids. Scientific-practical rheumatology. 2015;53:238-50 (in Russ.)]
  21. Strehl C., Bijlsma J.W., de Wit M., Boers M., Caeyers N., Cutolo M., Dasgupta B., Dixon W.G., Geenen R., Huizinga T.W., Kent A., de Thurah A.L., Listing J., Mariette X., Ray D.W., Scherer H.U., Seror R., Spies C.M., Tarp S., Wiek D., Winthrop K.L., Buttgereit F. Defining conditions where long-term glucocorticoid treatment has an acceptable low level of harm to facilitate implementation of existing recommendations: view points from an EULAR task force. Ann. Rheum. Dis. 2016;75:952-7.
  22. Schett G., Emery P., Tanaka Y., Burmester G., Pisetsky D.S., Naredo E., Fautrel B., van Vollenhoven R. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann. Rheum. Dis. 2016;75(8):1428-37.
  23. Verhoef L.M., Tweehuysen L., Hulscher M.E., Fautrel B., den Broeder A.A. bDMARD dose reduction in rheumatoid arthritis: a narrative review with systematic literature search. Rheumatol. Ther. 2017;4(1):1-24.
  24. Edwards C.J., Fautrel B., Schulze-Koops H., Huizinga T.W., Kruger K. Dosing down with biologic therapies: a systematic review and clinicians' perspective. Rheumatology (Oxford). 2017, Feb 16. doi: 10.1093/rheumatology/kew464 [Epub ahead of print].
  25. Stack R.J., van Tuyl L.H., Sloots M., van de Stadt L.A., Hoogland W., Maat B., Mallen C.D., Tiwana R., Raza K., van Schaardenburg D. Symptom complexes in patients with seropositive arthralgia and in patients newly diagnosed with rheumatoid arthritis: a qualitative exploration of symptom development. Rheumatology (Oxford). 2014;53(9):1646-53.
  26. van Steenbergen H.W., Aletaha D., Beaart-van de Voorde L.J. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann. Rheum. Dis. 2017;76(3):491-6.
  27. van Dongen H., van Aken J., Lard L.R., Visser K., Ronday H.K., Hulsmans H.M., Speyer I., Westedt M.L., Peeters A.J., Allaart C.F., Toes R.E., Breedveld F.C., Huizinga T.W. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;56(5):1424-32.
  28. Burgers L.E., Allaart C.F., Huizinga T.W.J., van der Helm-van Mil A.H.M. Brief report: clinical trials aiming to prevent rheumatoid arthritis cannot detect prevention without adequate risk stratification: a trial of methotrexate versus placebo in undifferentiated arthritis as an example. Arthritis Rheum. 2017;69(5):926-31.
  29. Van der Helm-van Mil A.H.M., le Cessie S., van Dongen H., Breedveld F.C., Toes R.E., Huizinga T.W. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: how to guide individual treatment decisions. Arthritis Rheum. 2007;56:433-40.
  30. Kohler L., Kirchoff T., Jablonka A., Schmidt R.E., Merkesdal S. Incidence of rheumatoid arthritis onset in patients with arthralgia and anti-citrullinated peptide antibody positivity; pilor study on effectiveness of hydroxychloroquine treatment. Rheumatology (Sunnyvale). 2016;6:196.
  31. Gerlag D.M., Norris J.M., Tak P.P. Towards prevention of autoantibody-positive rheumatoid arthritis: from lifestyle modification to preventive treatment. Rheumatology (Oxford). 2016;55(4):607-14.
  32. Deane K.D., Striebich C.C., Holers V.M. Editorial: prevention of rheumatoid arthritis: now is the time, but how to proceed? Arthritis Rheum. 2017;69:873-7.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies