Вопросы иммуногенности биологических препаратов: теория и практика

The variously faceted and clinically important problem of immunogenicity of recombinant biologicals that have become an integral part of therapy for inflammatory rheumatic diseases is considered.Рассматривается чрезвычайно многогранная и важная для клинической практики проблема иммуногенности генно-инженерных биологических препаратов, ставших неотъемлемой частью терапии воспалительных ревматических заболеваний

Ритуксимаб: новые возможности терапииревматоидного артрита

Some patients with rheumatoid arthritis (RA) are unresponsive or intolerant to both synthetic first-line anti-inflammatory drugs (FLAID) and tumor necrosis factor (TNF) а inhibitors already included into all the treatment standards . Along with the conventional methods for overcoming drug resistance - switching to another FLAID or another TNF а blocker, the use of biologicals with another mechanism of action rather than suppression of TNF а gives a good account of itself. Prominent among these agents is the anti-B-cell drug rituximab. The new possibilities of the therapy, which open up the use of rituximab in patients with RA, are discussed.Определенный процент больных ревматоидным артритом (РА) резистентны как к синтетическим базисным противовоспалительным препаратам (БПВП), так и к уже вошедшим во все стандарты лечения ингибиторам фактора некроза опухоли (ФНО) а или не переносят эти препараты. Наряду с обычными методами преодоления лекарственной резистентности - переключением на другой БПВП или другой блокатор ФНО а - хорошо себя зарекомендовало применение биологических препаратов с иным, нежели подавление ФНО а, механизмом действия. Среди этих препаратов основное место занимает анти-В-клеточный препарат ритуксимаб. Обсуждаются новые возможности терапии, которые открывает использование ритуксимаба у больных РА

Актуальные вопросы применения ингибиторов фактора некроза опухоли α при ревматоидном артрите

The use of tumor necrosis factor (TNF) а inhibitors in combination with methotrexate remains the basic method for treating active rheumatoid arthritis (RA). This line in antirheumatic therapy is rapidly developing. A number of unsolved issues associated with the selection of patients (particularly at the early stage of RA) to be treated with TNF а antagonists, the prediction of its efficiency, the study of comparative aspects of therapy are on the agenda. The Russia's emergence of the latest TNF а inhibitor adalimumab that has unquestioned merits opens new vistas for the treatment of RA.Применение ингибиторов фактора некроза опухоли (ФНО) а в комбинации с метотрексатом остается основным методом лечения активного ревматоидного артрита (РА). Это направление в противоревматической терапии стремительно развивается. На повестке дня - ряд нерешенных вопросов, связанных с отбором пациентов (особенно на ранней стадии РА) для лечения антагонистами ФНО а, прогнозированием его эффективности, изучением сравнительных аспектов терапии. Появление в России самого современного ингибитора ФНО а - адалимумаба, обладающего неоспоримыми достоинствами, открывает новые перспективы в лечении РА

Clinical efficiency of an education program for patients with rheumatoid arthritis

Objective: to develop an education program for patients with rheumatoid arthritis (RA) and to evaluate its efficiency. Subjects and methods. The study included 43 patients with RA: 23 study group patients were trained according to an education program (Rheumatoid Arthritis Health School), 20 patients formed a control group. The education program consisted of 4 daily 90-min studies. The MDHAQ (R798—NP2) questionnaire was used to determine DAS 28, HAQ, RAPID 3 scores at baseline and following 6 months. Results. Six months after education, the study group showed reductions in DAS 28 by 1.33+0.26 scores (р < 0.05), HAQ by 0.91±0.54 (55.2%; р < 0.01), and RAPID 3 by 5.96±0.92 (49.9%; р < 0.01), anxiety level by 0.86±0.32 (54.4%; р < 0.05), depression by 0.87±0.61 (53.4%; р < 0.05), fatigability by 3.39±1.17 (47.5%; р < 0.05); sleep improved by 0.81±0.36 scores (54.7%; р < 0.05). Six months following education program participation, there was significantly more frequently a good DAS 28 response to treatment according to the EULAR criteria (52.2% versus 30.0% in the control group; р < 0.05), and the number of patients who reported health improvement increased by 8.5 times (р < 0.01). The changes in the control group were less pronounced, which determined statistically significant differences between the groups in most indicators (р < 0.05). Conclusion. The education program improves functional capacities and psychological status, assists in controlling the disease activity, and enhances the quality of life in patients with RA

Non-steroidal anti-inflammatory drugs for osteoarthritis and non-specific back pain: basic provisions for effective and safe use (Interdisciplinary consensus)

The interdisciplinary council of leading experts has presented recommendations for the effective and safe use of non-steroidal anti-inflammatory drugs in osteoarthritis and non-specific back pain in general outpatient practice

Gastroduodenal safety of Nimesulid (Nimesil, Berlin Chemie) in rheumatic patients with history of ulcer

Objective. To assess safety of nimesulid in rheumatic pts with history of ulcer or multiple erosions (ME) of stomach and/or duodenal mucosa. Methods. 42 pts with rheumatic diseases aged 22-73 years were included. AH had gastric or duodenal ulcers or ME (n>10) connected with NSAID treatment and confirmed by endoscopy no more than 6 months before the beginning of the study. Pts were included after healing of ulcers and erosions. The pts were randomized to receive Nimesulid 200 mg/day (group 1) or Diclofenac suppositoria 100 mg/day + ranitidine 150 mg/day (group 2). Esophagogastroduodenoscopy was performed before and 12 weeks after the beginning of treatment. Results. Relapse of stomach ulcer was observed in I pts of group 1 (5,6%). Relapse of NSAID-induced ulcers and ME was noted in 6 pts of group 2 (33,3%): in 4 cases stomach ulcers, in 1 case stomach ME, in 1 case duodenal ulcer (p=0,0424). Presence of gastralgias and dyspepsia was noted in 36,8% pts of group 1 and in 20% pts of group 2 (p=0,0539). In 1 pts of group 2 gastralgias were the reason for premature endoscopy. Conclusion. Nimesil (Nimesulid) can be considered as a more safe drug than classical NSAIDs with smaller risk of serious gastroduodenal complications development in rheumatic pts with ulcer history. The results of the study allow to recommend Nimesulid as a drug of choice for treatment of pts with history of NSAID-induced gastropathy

The problems of THE immunogenicity of biologicals: theory and practice

The variously faceted and clinically important problem of immunogenicity of recombinant biologicals that have become an integral part of therapy for inflammatory rheumatic diseases is considered

DISEASE MODIFYING THERAPY AND OUTCOME OF RHEUMATOID ARTHRITIS: RETROSPECTIVE ASSESSMENT OF LONG-TERM RESULTS

Aim of study: To investigate the relation between patterns of basic treatment and the outcome of disease in patients with rheumatoid arthritis (RA). Material and methods: We studied retrospectively two groups of patients with RA (1987 ACR criteria): 1) main group - died (72 patients, mean duration of disease from the onset to death 12.8±0.9 years); 2) control group - alive to 1999 with duration of disease at least 15 years (90 patients, mean follow-up period 19.4±0.47 years). Results: Some patterns of basic treatment were observed: 1) "passive ” strategy - only hydroxychloroquine or sulphasalazine during many years; 2) "inteirupted " treatment - early treatment gold or cytotoxics, but when improvement occurred, therapy with DMARD was interrupted for 1-2 years or more, after that re-started etc.; 3) “emergency” strategy’ - 7-10years of "passive" treatment, after that se\>ere destruction and/or amyloidosis appeared, and cytotoxics started; 4) typical "pyramid " strategy; 5) "active " strategy - early start of treatment with active DMARD (melotrexate, gold) with consecutive change of DMARDs without interruption of basic treatment (very close to "sawtooth ” strategy). The most of died patients were treated with "passive ” and "interrupted" strategies, but the most of patients in control group were treated with "pyramid” and "active" strategies. Conclusion: active strategy of basic treatment has a positive influence on the survival ofpatients with R.A

RITUXIMAB: NEW POTENTIALITIES OF THERAPY FOR RHEUMATOID ARTHRITIS

Some patients with rheumatoid arthritis (RA) are unresponsive or intolerant to both synthetic first-line anti-inflammatory drugs (FLAID) and tumor necrosis factor (TNF) а inhibitors already included into all the treatment standards . Along with the conventional methods for overcoming drug resistance - switching to another FLAID or another TNF а blocker, the use of biologicals with another mechanism of action rather than suppression of TNF а gives a good account of itself. Prominent among these agents is the anti-B-cell drug rituximab. The new possibilities of the therapy, which open up the use of rituximab in patients with RA, are discussed

DISEASE MODIFYING THERAPY AND OUTCOME OF RHEUMATOID ARTHRITIS: RETROSPECTIVE ASSESSMENT OF LONG-TERM RESULTS

Aim of study: To investigate the relation between patterns of basic treatment and the outcome of disease in patients with rheumatoid arthritis (RA). Material and methods: We studied retrospectively two groups of patients with RA (1987 ACR criteria): 1) main group - died (72 patients, mean duration of disease from the onset to death 12.8±0.9 years); 2) control group - alive to 1999 with duration of disease at least 15 years (90 patients, mean follow-up period 19.4±0.47 years). Results: Some patterns of basic treatment were observed: 1) "passive ” strategy - only hydroxychloroquine or sulphasalazine during many years; 2) "inteirupted " treatment - early treatment gold or cytotoxics, but when improvement occurred, therapy with DMARD was interrupted for 1-2 years or more, after that re-started etc.; 3) “emergency” strategy’ - 7-10years of "passive" treatment, after that se\>ere destruction and/or amyloidosis appeared, and cytotoxics started; 4) typical "pyramid " strategy; 5) "active " strategy - early start of treatment with active DMARD (melotrexate, gold) with consecutive change of DMARDs without interruption of basic treatment (very close to "sawtooth ” strategy). The most of died patients were treated with "passive ” and "interrupted" strategies, but the most of patients in control group were treated with "pyramid” and "active" strategies. Conclusion: active strategy of basic treatment has a positive influence on the survival ofpatients with R.A