«TREAT-TO-TARGET» (T2T) STRATEGY IN SPONDYLOARTHRITIS

The paper briefly presents some specific characteristics of development of a treat-to-target (T2T) strategy for spondy- loarthritis (SA). The reasons for some inconsistencies between the current concept of SA and the name of the paper presenting the program are described shortly. A complete Russian translation of the T2T strategy for this disease is given and major problems in its development are outlined. The main goal of therapy is shown to achieve clinical remission or low disease activity; however, there has not yet been a final definition of this condition

Последние достижения и перспективы терапии аксиального спондилоартрита / анкилозирующего спондилита

Well-established and some little-known treatments of axial spondyloarthritis / ankylosing spondylitis (AS), which have appeared in recent years are discussed, also discussed are emerging trends for AS treatment.В статье рассмотрены как хорошо изученные, так и некоторые малоизвестные методы лечения аксиального спондилоартрита / анкилозирующего спондилита (АС), которые появились в последние годы, а также перспективные направления терапии АС

ВОЗМОЖНОСТИ И РЕЗУЛЬТАТЫ НЕПРЯМОГО СРАВНЕНИЯ ГЕННО-ИНЖЕНЕРНЫХ БИОЛОГИЧЕСКИХ ПРЕПАРАТОВ ПРИ АНКИЛОЗИРУЮЩЕМ СПОНДИЛИТЕ

The paper analyzes two matching-adjusted indirect comparison-based investigations of the efficacy of adalimumab (ADA) and secukinumab (SCM) in active ankylosing spondylitis, which have been recently reported at the EULAR Congress (London, 2016). One study sponsored by AbbVie was conducted to determine the short-term (16-week) comparative clinical and economic efficacy of the test drugs and the other was supported by Novartis to reveal long-term (52-week), only clinical efficacy. Both studies have shown that the short-term efficacy ofADAand SCM is practically similar; however, the latter has a better long-term clinical efficacy. A pharmacoeconomic analysis of both drugs used during the first 12 weeks has demonstrated some advantage ofADA. Представлен анализ двух исследований, основанных на методе согласованного скорректированного непрямого сравнения эффективности адалимумаба (АДА) и секукинумаба (СКМ) при активном анкилозирующем спондилите, которые были доложены на последнем конгрессе EULAR (Лондон, 2016). Одно исследование выполнено при финансовой поддержке компании «ЭббВи» и направлено на выявление краткосрочной (до 16 нед) сравнительной клинической и экономической эффективности изученных препаратов, а второе – компании «Новартис» и проведено с целью выявления долгосрочной, до 52 нед, только клинической эффективности. В обоих исследованиях было показано, что краткосрочная эффективность у АДА и СКМ практически сходная, однако длительная клиническая эффективность лучше у СКМ. Фармакоэкономический анализ первых 12 нед использования обоих препаратов показал некоторое преимущество АДА

Возможност и голимумаба в терапии анкилозирующего спондилита

The paper summarizes the data of the GO-RAISE trial evaluating the efficacy and tolerability of golimumab (GLM) in patients with ankylosing spondylitis (AS). The trial was launched in 57 clinical centers of North America, Europe, and Asia in 2005. It enrolled 356 patients with high AS activity (BASDAI≥4) in whom previous and current therapies with nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying anti-rheumatic drugs were ineffective. Group 1 patients received subcutaneous placebo; Group 2 had subcutaneous GLM 50 mg; Group 3 took GLM 100 mg every 4 weeks. Concomitant therapy with methotrexate, sulfasalazine, hydroxychloroquine, glucocorticoids, and NSAIDs was continued in previous doses. The investigators have concluded that GLM therapy in patients with AS gives rise to a rapid clinical and radiographic response that persists for a long time. Although no comparative trials of GLM versus other tumor necrosis factor-α (TNF-α) inhibitors used to treat AS have conducted, the available data show that its efficacy and tolerability in these patients are similar to those of the TNF-α inhibitors already used in Russia. The GLM dose of 100 mg is noted to be worse tolerated than that of 50 mg with their practically equal clinical efficacy. The standard dose of GLM is 50 mg subcutaneously administered once monthly for all indications, including also for AS.Обобщены данные исследования GO-RAISE, в котором оценивали эффективность и переносимость голимумаба (ГЛМ) у больных анкилозирующим спондилитом (АС). Исследование стартовало в 2005 г. в 57 клинических центрах Северной Америки, Европы и Азии. В исследование включено 356 больных АС с высокой активностью (BASDAI≥4), у которых предшествующая и настоящая терапия нестероидными противовоспалительными препаратами (НПВП) или болезньмодифицирующими антиревматическими препаратами была неэффективна. Пациенты 1-й группы получали подкожно плацебо, 2-й группы – ГЛМ подкожно по 50 мг и 3-й группы – ГЛМ по 100 мг каждые 4 нед. Сопутствующая терапия метотрексатом, сульфасалазином, гидроксихлорохином, глюкокортикоидами и НПВП продолжалась в прежних доза. Исследователями сделан вывод, что терапия ГЛМ у пациентов с АС приводит к развитию быстрого клинического и рентгенологического ответа, который сохраняется длительное время. Хотя при АС не проводилось сравнительных контролируемых исследований ГЛМ с другими ингибиторами ФНО, имеющиеся данные показывают, что его эффективность и переносимость у таких пациентов соответствуют таковым уже использующихся в России ингибиторов ФНОα. Отмечено, что доза ГЛМ 100 мг переносилась хуже, чем доза 50 мг, при практически равной их клинической эффективности. Для всех показаний, в том числе и для АС, стандартной дозой ГЛМ является 50 мг с подкожным введением один раз в месяц

Прогрессирование аксиального спондилоартрита

The spectrum of bone lesions in axial spondyloarthritis is of great interest. With inflammation and mechanical influence concurrence in the background, both tissue gain and tissue loss in a particular bone area can occur simultaneously. Moreover, if vertebral bone mass loss, perhaps, can be easily explained by chronic systemic inflammation, the reason of its gain, observed in axial spondyloarthritis remains a mystery. It is unclear whether it is a consequence of enhanced recovery processes after injury, adaptation to altered mechanical stress, response to inflammatory cells activation or cytokines, produced by them, or changes in Wnt signaling pathways (for example). Whether these factors act individually or collectively is also unclear.Разнообразие поражения костной ткани при аксиальном спондилоартрите вызывает большой интерес. На фоне конкурирующих между собой воспаления и механических воздействий на конкретном участке кости одновременно может происходить как прирост ткани, так и ее потеря. Причем, если потерю костной массы позвонков, пожалуй, легко объяснить хроническим системным воспалением, то ее новообразование, наблюдаемое при аксиальном спондилоартрите, остается загадкой. Неясно, является ли оно следствием усиления процессов восстановления после повреждения, адаптации к измененной механической нагрузке, реакции на активацию участвующих в воспалении клеток или продуцируемых ими цитокинов либо изменения в сигнальных путях Wnt (как пример), а также действуют ли эти факторы по отдельности или совокупно

ERGOTHERAPY IN RHEUMATOLOGY

The article reports one of the most affordable rehabilitation methods, i.e. occupational therapy. The issues related to the history of occupational therapy as a treatment method, its application in rheumatology and promising directions of development are covered

HIGH PREVALENCE OF REACTIVE ARTHRITIS IN RUSSIA: OVERDIAGNOSIS OR REALITY?

Reactive arthritis (ReA) is one of the types of spondyloarthritis. According to the statistics reports by the Ministry of Health of Russia, the prevalence of ReA in 2013 was 42.8 per 100,000 adult population, 99, and 172.4 per 100,000 children aged 0–14 and 15–17 years, respectively. There is a wide scatter of ReA detection rates in both the federal districts and subjects of the Russian Federation, which may be associated with both the spread of sexually transmitted infections, asymptomatic trigger Chlamydia infection, and overdiagnosis of ReA

HLA-B27-associated uveitis: From pathogenesis to therapy

Uveitis is the inflammation of the uvea, which generally occurs in young people and may be accompanied by serious complications leading to disability. The review analyzes the data of Russian and foreign investigations on the pathogenesis of HLA-B27-associated uveitis occurring in different diseases from a group of seronegative spondyloarthritides (SpA) and also discusses current therapeutic approaches in this disease.Since the late 20th century, there has been rapid progress in studying the pathogenesis of HLA-B27-associated uveitis and in identifying the genetic factors predisposing to this pathology. Investigations of HLA-B27 antigen and its alleles are being continued. Tumor necrosis factor-α (TNF-α), the higher levels of which in blood, synovial fluid, and ocular fluid in rheumatic diseases has been proven in many works of both foreign and Russian scientists, is most studied among the inflammatory mediators. Due to the key role of this cytokine in the development of inflammation, drugs inhibiting TNF-α activity have been designed and successfully used in the past decade, which results in partial and occasionally stable remission

HLA-B27-ASSOCIATED UVEITIS: EPIDEMIOLOGY, CLINICAL PICTURE, AND COMPLICATIONS

Anterior uveitis is the most common form of intraocular inflammation. Among them, HLA-B27-associated uveitis occupies one of the leading places, which may be an independent disease or one of the manifestations of spondy- loarthritis (SA). The paper considers the general issues of the nomenclature and classification of uveitis, by using the classification criteria of the International Uveitis Study Group and the Standardization of Uveitis Nomenclature Workshop. The epidemiological aspects of uveitis are described. Emphasis is laid on a difference in the detection rate of uveitis in different countries, in men and women, as well as in different forms of SA. The clinical features of SA- associated uveitis and its complications are discussed

Relationship of the clinical characteristics of rheumatoid arthritis to work capacity and efficiency

Objective: to study the impact of the clinical characteristics of rheumatoid arthritis (RA) on work efficiency. Subjects and methods. One hundred and thirty-seven patients (116 women and 21 men) with RA were examined. Their mean age was 52.03+13.17 years; mean age at disease onset was 42.12+14.43 years. Median RA duration was 84 (range 24-174) months. DAS 28 for RA was moderate. The HAQ score was 1.42+0.82. Results. Fifty-nine (43%) of the 137 patients were in work. Absenteeism was 28.2%. It was equal to 0 in 28 of the 59 working subjects. The mean presenteeism was 42.3±27.9%. The reduction of overall work efficiency was 54.8±34.4%. The day-to-day activity determined in all the patients was reduced by 53.6±25.7%. Absenteeism turned out to be negatively related to RA duration (R = 0.26). DAS 28 scores were directly related to all WPAI indicators: absenteeism (R = 0.28), presenteeism (R = 0.63), lower overall work efficiency (R = 0.47), day-to-day activity (R = 0.64). The WPAI indicators (R >0.5), exclusive of absenteeism, were noted to have the strongest correlation with VAS pain intensity. The HAQ score was unassociated with absenteeism, but its association with presenteeism, lower overall work efficiency, and day-to-day activity proved to be high (R = 0.65; R = 0.43; R = 0.75, respectively). The correlation of the WPAI components with the transformed index of a patient's physical state (SF-36 PCS) was much higher than that with mental one (MCS). Conclusion. RA activity had a major influence on work efficiency. Presenteeism was much stronger related to the clinical characteristics of RA than with absenteeism. All WPAI scores were associated with activity, degree of functional defect, quality-of-life values, and fatigability. At the same time, absenteeism was least related to the clinical characteristics of RA