За последнее время подходы к лечению ревматоидного артрита (РА) претерпели значительные изменения. Существенно расширились возможности оказания эффективной помощи больным РА благодаря появлению новых противоревматических препаратов. Однако можно без преувеличения сказать, что успехи, которые были достигнуты в лечении данного заболевания, в равной степени обусловлены разработкой новых принципов ведения больных. Использование их в клинической практике позволяет наиболее полно реализовать терап евтический потенциал имеющихся лекарственных
О р и г и н а л ь н ы е и с с л е д о в а н и я ФГБНУ Научноисследовательский институт ревматологии им. В.А. Насоновой,
BackgroundInterstitial lung disease (ILD) is the most common internal organ manifestation of idiopathic inflammatory myopathies (IIM) that can severely affect the course of the disease. IIM patients with ILD often show resistance to conventional treatment with glucocorticoids (GC) and cytotoxic drugs so addition of biologic agents is an interesting possibility.ObjectivesTo assess efficacy and tolerability of rituximab (RTM) in IIM patients with ILD.MethodsIIM patients fulfilling Bohan and Peter criteria and having ILD were followed up in the Nasonova Research Institute of Rheumatology from 2009 to 2015. RTM was administered in case of intolerance or inadequate response to GC and other immunosuppressive drugs. Manual muscle testing (MMT), dyspnea assessment according to NYHA, creatinkinase (CK) and anti-Jo-1 antibodies (anti-Jo-1) assay; forced vital capacity (FVC) and carbon monoxide diffusion capacity (DLCO) evaluation as well as high-resolution computed tomography (HRCT) scanning of the chest were performed at baseline, 6–12 and 18–24 months after inclusion.Results41 patients (34 females, 7 males) with median age 50 [44;56], median disease duration 24 months [7;108] were included. 28 from them had decreased MMT value and class 1–2 NYHA dyspnea was present in 19. 18 patients were positive for anti-Jo-1 and 15 had elevated CK level. HRCT showed ILD signs including ground glass opacities (GGO) in all cases. FVC<80% was revealed in 16 and DLCO<80% - in 32 cases. All patients received GC 10–90 mg/day equivalent to prednisolone, 28 were treated with immunosuppressive agents (cyclophosphamide or mycophenolate mofetil). Patients received RTM courses consisted from 2 infusions of RTM 1000 or 500 mg at days 0 and 14. 1 RTM course was provided in 13, 2 – in 10, 3 – in 11, 4 – in 2, 5 – in 2, and 8 – in 3 patients. The follow up lasted for at least 12 months in 33, and for at least 24 months – in 15 patients. Dyspnea subsided and CK level decreased to normal values in all patients within 6–12 months after the first RTM infusion. 16 patients improved FVC by >10%, and 7 demonstrated DLCO increase by >10%. Worsening of pulmonary function tests was documented in 2 cases, while in the rest they were stable. After 18–24 months of follow up FVC remained +10% better vs baseline value in 10, DLCO – in 8 patients. In the rest patients these parameters remained stable. ILD was not progressing in 27 patients based on HRCT images in 6–12 months, moreover GGO lesions count was reduced in 10 patients, but there were cases of ILD worsening documented in 6 patients. Although, HRCT monitoring in 18–24 months showed ILD improvement in 7 patients and worsening – in 2, in remaining patients ILD was stable. Comorbid infections were documented in 18 patients, commonly manifesting in 2–3 months after the first RTM infusion.ConclusionsRTM treatment allows to achieve stable disease without typical for this condition further progression of pulmonary lesions in the majority of IIM patients with ILD.Disclosure of InterestNone declared
Остеоартрит (ОА) -хроническое прогрессирующее за-болевание суставов, сопровождающееся формированием необратимых изменений опорно-двигательного аппарата и развитием функциональной недостаточности. ОА принято рассматривать не как единую нозологическую форму, а ско-рее как группу заболеваний с различными этиологическими факторами и патогенетическими механизмами. У лиц по-жилого возраста хроническая боль, обусловленная ОА, яв-
Background According to Treat to Target (T2T) recommendations the primary goal of treatment of patients (pts) with rheumatoid arthritis (RA) is clinical remission. This implies a revision of treatment every 3-6 months with the use of combination therapy if necessary. Assessment of the results of applying the T2T strategy into practice is an important task. Objectives To study the results of treatment according the T2T strategy in pts with RA in clinical practice. Methods The REMARCA (Russian investigation of MethotrexAte and biologics in eaRly aCtive inflammatory Arthritis) investigator-initiated trial includes pts with asevere ctive RA. All pts started treatment with SC MTX monotherapy using fast increase from 10 to 25-30 mg/week. To exclude the influence of steroids, we allowed only 2 intra-articular injections per every 3 months (pts could continue steroids per os in low doses if prescribed before the enrollment in the study). Therapy was revised every 3 months using DAS28, SDAI and CDAI indices. The goal of treatment was clinical remission or low disease activity (LDA) as quickly as possible. Results By January 2014, 210 pts with RA were included, and 88 pts have passed the 12 months control point (22 males, 66 females, 92% IgM RF positive, 87,5% anti-CCP positive, including 46 pts with early RA (duration≤6 months) and 42 pts with long-standing RA (duration 22 [11;53] months). At 6 months we achieved LDA or remission according to DAS28 in 43 (49%), SDAI in 53 (60%), CDAI in 55 (63%) of pts. At 12 months LDA or remission were observed by DAS28 in 54 (61%) of pts, SDAI – 65 (74%), CDAI in 67 (76%) of pts. Combination with biologics (in most cases TNF inhibitors) was used in 57 (65%) of pts at (median) 3 [3;6] month. There were 13 cases of switching between biologics. Remission was observed more often during the first 6 months among patients who did not require biological therapy, but at 12 month combination therapy group showed similar results (table 1). “Functional remission” (HAQ≤0,5) was observed significantly more frequently in patients with good initial response to SC MTX. Patients with early RA significantly less likely required treatment with biologics (52%) than patients with long-standing RA (79%, p=0,014). Table 1. Remission rates at 6 and 12 months of treatment Patients characteristic MTX monotherapy, MTX + biologics, p n=31* n=57* (chi-square) DAS28 remission at 6 months, n=21 12 (39%) 9 (16%) 0,001 DAS28 remission at 12 months, n=41 15 (48%) 26 (46%) 0,26 SDAI remission at 6 months, n=17 10 (32%) 7 (12%) <0,001 SDAI remission at 12 months, n=34 15 (48%) 19 (33%) 0,31 CDAI remission at 6 months, n=17 11 (35%) 6 (11%) <0,001 CDAI remission at 12 months, n=32 14 (45%) 18 (32%) 0,27 HAQ ≤0,5 at 6 months, n=39 20 (65%) 19 (33%) 0,015 HAQ ≤0,5 at 12 months, n=46 21 (68%) 25 (44%) 0,017 *Percentage in column. Conclusions SC MTX monotherapy allowed to achieve LDA or remission in the vast majority of patients with good response to treatment. In patients who did not...
Background:The patient-reported outcomes are important components of quantitative methods of rheumatoid arthritis (RA) activity assessment which are used to choose the appropriate drug therapy. The value of these parameters can be significantly affected not only by the inflammatory process, but also by the psychological characteristics of the patient and, in particular, by hardiness [1].Objectives:To study the relationship between psychological factors and signs of RA activity.Methods:Patients with RA who met the EULAR/ACR 2010 criteria, and observed at the V. A. Nasonova Research Institute of Rheumatology were included. Clinical examination was performed including patient global assessment (PGA), physician global assessment (PhGA), pain measurement on a visual analog scale, tender joint count (TJC), swollen joint count (SJC). The functional status was determined by HAQ, the quality of life – by SF-36 EQ-5D, the nature of pain – by painDETECT, the presence of anxiety and depression – by HADS. Patients also completed Hardiness Survey questionnaire to assess hardiness (HDS) and 3 components of the HDS – commitment (CMT), control (CT) and challenge (CLN). Disease activity was evaluated with DAS28, CDAI, and RAPID3. All patients signed informed consent to participate in the study. Analysis of the data was performed using Spearman’s rank test, Fisher exact test, qui-square and t-tests.Results:85 patients with RA were included. There were 69 women and 16 men. Mean age was 56.7±13.1 years, disease duration – 7.6±2.7 years. 72 patients were positive for rheumatoid factor, 75 – for anti-cyclic citrullinated peptide antibody. CDAI showed high activity in 15, moderate – in 37, low – in 30, and remission in 3 patients, DAS 28 – in 10, 55, 12, and 8, and RAPID3 – in 24, 25, 15, and 21, respectively. 24 patients had subclinically or clinically expressed anxiety and 15 –subclinically or clinically expressed depression (≥8 according to HADS). In 31 patients, the painDETECT questionnaire revealed possible or probable neuropathic pain. Mean HDS was 84.8±21.7, CMT – 38.9±9.2, CT – 29.4±8.6, CLN – 17.3±7.1. These values were comparable with the corresponding population data for this age group. There was a significant inverse correlation between HDS and RA activity measures, including SJC, TJC, DAS28 (p<0.05), pain, PGA, PhGA, CDAI, RAPID3, and HAQ (p<0.01). In addition, HDS and all its components positively correlated with quality of life, assessed by SF-36 and EQ-5D (p<0.01). In patients with subclinically and clinically expressed anxiety and depression, HDS, CMT, and CT were significantly lower than in patients without anxiety and depression (p<0.01), while the values of CLN in these groups did not differ significantly.Conclusion:The results of the present study suggest that low HDS may be one of the significant factors determining RA activity level because it does not allow patients to adapt adequately to a stressful situation produced by the disease.References:[1]Maddi SR. Am Psychol. 2008 Sep;63(6):563-4.Disclosure of Interests:None declared
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