Curation of rheumatic arthritis patients: modern recommendations and real clinical practice


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Article contains recommendations from European League Against Rheumatism of 2016 and national recommendations concerning management of rheumatic arthritis patients from 2017. Also results of treatment the patients with early stage of the disease in accordance with these recommendations are introduced. Aim of the research. Estimation of the efficacy and acceptability of subcutaneous form of methotrexate while perspective observation of early rheumatic arthritis patients. Material and methods. Subcutaneous form of methotrexate (15 mg/week in combination with 1-2 mg of folic acid) was prescribed to 67 patients with firm rheumatic arthritis diagnosis according to ACR/EULAR criteria of 2010. During 12 months 65 patients (97%) were treated, 24 months - 47, and 36 months - 22 patients. Treatment was performed in accordance with the strategy of RA treatment principles «Treat to Target». Initial activity of RA according to DAS28 in 43patients (64%) was moderate and in 24 (36%) - high. Results. Practically in all the patients the first symptoms of improvement were fixed after 4-5 weeks of methotrexate use in 15mg/week dosage; up to the 8th week of therapy the effect was fixed in all the patients. After 6 months of therapy was fixed no signs of high rheumatic arthritis activity, moderate activity took place in 32 from 65 (49%) of patients, and low - in 33 (51%) cases. In 2 years of treatment 43% of patients had a remission, the rest of patients had low activity of RA; in 3 years more than half of the patients had a remission. Conclusion. Subcutaneous form of methotrexate has a high efficacy to the activity and progressing of early rheumatic arthritis, long-lasting good acceptability and lets to reach the goal in majority of patients after 6-12 months of therapy (while using principles of controlled treatment including teaching patients). In case of controlled treatment with timely therapy correction in case of insufficient antiinflammatory effect, and teaching of patients, it is possible significantly improve the results of rheumatic arthritis treatment, get clinical laboratory remission more than in half of patients and avoid the destruction of joints.

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作者简介

Natalya Chichasova

Federal State Autonomous Education Institution of Higher Education I.M. Sechenov «First Moscow State Medical University Under the Ministry of Health of the Russian Federation»

Email: KafedraRheum@yandex.ru
MD, professor of the Department of rheumathology

Elena Igolkina

Federal State Autonomous Education Institution of Higher Education I.M. Sechenov «First Moscow State Medical University Under the Ministry of Health of the Russian Federation»

Email: KafedraRheum@yandex.ru
PhD, associate professor of the Department

Gyuzel Imametdinova

Federal State Autonomous Education Institution of Higher Education I.M. Sechenov «First Moscow State Medical University Under the Ministry of Health of the Russian Federation»

Email: KafedraRheum@yandex.ru
PhD, associate professor of the Department of rheumatology

Evgeny Nasonov

V.A. Nasonova institute of rheumatology FSBI

Email: sokrat@irramn.ru
academician of RAS, MD, professor, president of the Association of rheumatologists of Russia, chief supernumerary rheumatologist of the Ministry of Healthcare of Russia, research advisor

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