Циклоспорин А при ревматоидном артрите: современные данные

Despite the advent of the new class of medications, such as gene engineering biologicals, the use of traditional essential anti-inflammatory drugs (EAID) remains the most important method of pathogenetic therapy for rheumatoid arthritis (RA). Apart from methotrexate (MT) that is the gold standard of treatment for RA, there are a number of other effective EAIDs, including cyclosporine A (CsA, Sandimmun). The review deals with the practical aspects of using CsA in RA. Particular emphasis is laid on the capacities of combined basic therapy with CsA and MT in early RA and on the use of CsA in patients with concomitant chronic viral diseases (including viral hepatitis C).Несмотря на появление нового класса лекарственных средств - генно-инженерных биологических препаратов - важнейшим методом патогенетической терапии ревматоидного артрита (РА) остается применение традиционных базисных противовоспалительных препаратов (БПВП). Помимо метотрексата (МТ), который является «золотьм стандартом» лечения РА, существует ряд других эффективных БПВП, к которым относится циклоспорин А (ЦсА, Сандиммун). Обзор посвящен практическим аспектам применения ЦсА при РА. Особое внимание уделено возможностям комбинированной базисной терапии ЦсА и МТ при раннем РА, а также применению ЦсА у больных, имеющих сопутствующие хронические вирусные заболевания (в частности, вирусный гепатит С)

CYCLOSPORINE A IN RHEUMATOID ARTHRITIS: CURRENT DATA

Despite the advent of the new class of medications, such as gene engineering biologicals, the use of traditional essential anti-inflammatory drugs (EAID) remains the most important method of pathogenetic therapy for rheumatoid arthritis (RA). Apart from methotrexate (MT) that is the gold standard of treatment for RA, there are a number of other effective EAIDs, including cyclosporine A (CsA, Sandimmun). The review deals with the practical aspects of using CsA in RA. Particular emphasis is laid on the capacities of combined basic therapy with CsA and MT in early RA and on the use of CsA in patients with concomitant chronic viral diseases (including viral hepatitis C)

Current Management Strategy for Osteoarthritis Patients: a Review

A strategic approach is crucial to the management of patients with osteoarthritis (OA). It should be based on the current understanding of the pathogenesis of OA as an inflammatory disease. A review of current clinical guidelines for the management of patients with OA shows significant differences in the evaluation of pharmacological approach, especially the place of symptomatic slow-acting drugs for osteoarthritis, (SYSADOA) and a certain consensus in relation to non-pharmacological methods (primarily exercise, patient education, body weight control, various physiotherapy methods, orthotics and massage/manual therapy). It should also be taken into account the international “treat to target” recommendations, the main idea of which is careful regular monitoring of the patient’s condition and adaptation of treatment tactics depending on the response to treatment. Based on the analysis of literature data and their own clinical experience, the authors developed an algorithm for the strategy of complex therapy of OA, including the following steps: 1) pain control (2-4 weeks), 2) inflammation control (4-6 weeks); 3) control over cartilage degradation (6 weeks – 12 months). For each stage, a specific combination of systemic pharmacotherapy (non-steroidal anti-inflammatory drugs, SYSADOA), intra-articular administration of glucocorticoids and hyaluronic acid, exercises and magnetotherapy (pulsed electromagnetic field) was proposed. A staged comprehensive strategy for the treatment of patients with OA should help to achieve control over the symptoms, while minimizing the duration of NSAIDs and avoiding polypharmacy, and further achievement of inhibition of structural progression

Determination of Heterogeneous Proteomic and Metabolomic Response in anti-TNF and anti-IL-6 Treatment of Patients with Rheumatoid Arthritis

Reduction in tumor necrosis factor (αTNF) and interleukin-6 (IL-6) activities is a widely utilized strategy for the treatment of rheumatoid arthritis (RA) with a high success rate. Despite both schemes targeting the deprivation of inflammatory reactions caused by the excessive activity of cytokines, their mechanisms of action and the final output are still unequal. This was a comparative longitudinal study that lasted for 24 weeks and aimed to find the answer to why the two schemes of therapy can pass out of proportion in attitude of their efficiency. What are the differences in metabolic and proteomic responses among patients who were being treated by either the anti-TNF or anti-IL-6 strategy? We found increased levels of immunoglobulins A and G (more than 2-fold in anti-IL-6 and more than 4-5-fold in anti-TNF groups) at the final stage (24 weeks) of monitoring but the most profound increase was determined for µ-chains of immunoglobulins in both groups of study. Metabolomic changes displayed main alterations with regard to arginine metabolism and collagen maintenance, where arginine increased 8.86-fold (p p p p < 0.05) in the anti-IL-6 group, but the growth dynamics in the anti-IL6 group was delayed (gradually raised at week 24) compared to the anti-TNF group (raised at week 12) following a smooth reduction. The ELISA analysis of IL-6 and TNFα concentration in the study population supported proteomic and metabolomic data. A positive correlation between ΔCDAI and ΔDAS28 indicators and ESR and CRP was established for the majority of patients after 24 weeks of treatment where ESR and CRP reduced by 20% and 40% finally, respectively. A regression model using the Forest Plot was estimated to elucidate the impact of the most significant clinical, biochemical, and anthropometric indicators for the evaluation of differences between considered anti-TNF and anti-IL-6 schemes of therapy

Reevaluation of the role of duration of morning stiffness in the assessment of rheumatoid arthritis activity.

OBJECTIVE: To evaluate the utility of the duration of morning stiffness (MS), as a patient-reported outcome (PRO), in assessing rheumatoid arthritis (RA) disease activity. METHODS: We acquired information on 5439 patients in QUEST-RA, an international database of patients with RA evaluated by a standard protocol. MS duration was assessed from time of waking to time of maximal improvement. Ability of MS duration to differentiate RA activity states, based on Disease Activity Score (DAS)28, was assessed by analysis of variance; and a receiver-operating characteristic (ROC) curve was plotted for discriminating clinically active (DAS28 &gt; 3.2) from less active (DAS28 3.2). CONCLUSION: MS duration has a moderate correlation with RA disease activity. Assessment of MS duration may be clinically helpful in patients with low RAPID3 scores.</or=