Ревматоидный артрит (РА) -хроническое воспалительное заболевание с преимущественным поражением суставов, сопровождающееся функциональными нарушениями, снижением качества жизни (КЖ) и потерей трудоспособности больных.В число основных задач лечения больного с РА входят обеспечение максимально продолжительного сохранения высокого КЖ, нормализация функционального статуса и социальных возможностей пациента. Для выполнения этих задач лечение РА следует проводить до достижения определенной цели -ремиссии или, как минимум, низкой активности заболевания, оценивая ак-тивность каждые 3-6 мес и соответствующим образом корригируя терапию [1].Обычно активность РА определяют с использованием комплексного подхода, подразумевающего одновременную регистрацию нескольких клинических и лабораторных показателей. Золотым стандартом для количественной оценки активности РА в настоящее время является индекс DAS 28, основанный на подсчете числа болезненных (ЧБС) и припухших суставов (ЧПС), общей оценке состояния здоровья больным (ООСЗ) по визуальной аналоговой шкале (ВАШ), а также определении уровня С-реактивного белка (СРБ) или СОЭ [2]. На О Р И Г И Н А Л Ь Н Ы Е И С С Л Е Д О В А Н И Я НАУЧНО-ПРАКТИЧЕСКАЯ РЕВМАТОЛОГИЯ, 2011, № 4, 36-40 А.С. Старкова, В.Н. Амирджанова Учреждение Российской академии медицинских наук Научно-исследовательский институт ревматологии РАМН, Москва ВАЛИДАЦИЯ РУССКОЯЗЫЧНОЙ ВЕРСИИ ОПРОСНИКА RAPID-3 Контакты: Анна Сергеевна Старкова knot_me@mail.ruЦель -оценить психометрические свойства русскоязычной версии опросника RAPID-3 у больных ревматоидным артритом (РА). Материал и методы. Оценивались надежность, чувствительность и валидность индекса RAPID-3 у 100 больных с достоверным РА. Оценка надежности включала изучение воспроизводимости и внутреннего постоянства индекса. Воспроизводимость оценивалась методом тест-ретест анализа, внутреннее постоянство -путем вычисления коэффициента Кронбаха α; чувствительность -при сопоставлении значений индекса RAPID-3 с ответом на терапию по критериям ACR-50. Конструктивная валидность определялась при помощи корреляционного анализа с «внешними критериями». Результаты. У пациентов со стабильным состоянием здоровья тест-ретест анализ не выявил статистически значимых различий между первоначальным (15,17±5,57) и повторным (13,1±5,89) значениями индекса RAPID-3, коэффициент Кронбаха α составил 0,8. Улучшение состояния здоровья пациентов по критериям ACR-50 коррелировало с улучшением показателей RAPID-3. Уменьшение активности заболевания по индексу RAPID-3 было более выраженным у пациентов, достигших 50% улучшения по критериям ACR. Снижение индекса RAPID-3 после лечения в среднем составило 3,9±0,1 балла. У пациентов, не достигших 50% улучшения ко времени выписки из стационара, изменение активности заболевания было менее выраженным (Δ RAPID-3= 1,9 ±0,2 балла). Выявлены высокие корреляционные взаимосвязи значения индекса RAPID-3 с клиническими показателями: числом припухших суставов (R=0,61), числом болезненных суставов (R=0,46), комбинированными индексами активности DAS 28 (R=0,72), просты...
Family and twin studies have shown that ankylosing spondylitis (AS) has a hereditary nature that is based on a strong association with the leukocyte antigen HLA-B27. However, only 1–5% of HLA-B27 carriers develop AS, which indicates that there are other genetic markers involved in the formation of a predisposition to this disease. A number of genome-wide association studies have convincingly confirmed the role of the STAT4 gene. This gene encodes the protein – the signal transducer and activator of transcription (STAT) protein, which is a predisposing factor for the development of many autoimmune diseases. There are not so many studies of the relationship of STAT4 polymorphisms to the predisposition to AS, and there are no these studies regarding the Russian population.Objective: to study whether there is a possible association of STAT4 rs7574865 gene polymorphism with the predisposition to AS and to assess the activity of this disease using BASDAI and ASDAS scores in the Russian patient population.Patients and methods. A cohort of 203 individuals, including 100 patients (79 men and 21 women) with AS, and 103 healthy volunteers (a control group) was surveyed. Age, gender, duration, and specific features of AS onset, ESR, and CRP levels were assessed. BASDAI and ASDAS scores were calculated to evaluate disease activity.Results and discussion. There was a significant relationship between STAT4 polymorphism and C-reactive protein (CRP) levels and BASDAI and ASDAS-CRP scores. The TT genotype carriers had significantly higher mean activity indices compared to the GG (p=0.001) and GT (p=0.005) genotype carriers for CRP, BASDAI (p=0.0001 and p=0.009, respectively) and ASDAS-CRP (p=0.009 and p=0.001, respectively). High disease activity (BASDAI >4 and ASDAS-CRP >3.5) was also associated with the high frequency of the T allele (p=0.046 and p=0.004, respectively). The value of STAT4 rs7574865 gene polymorphism in the pathogenesis of autoimmune diseases is confirmed by a study in which the T allele in STAT4 rs7574865 enhances mRNA transcription and protein expression. Italian authors have shown that there is a relationship between the minor T allele of rs7574865 and the high risk of arthritis. We have previously established a relationship between the T allele and the predisposition to diffuse systemic scleroderma, interstitial lung damage, and elevated anti-topoisomerase I antibody levels.Conclusion. The present study has shown for the first time a significant association of STAT4 rs7574865 polymorphism with the main AS activity indicators: CRP levels, BASDAI and ASDAS-CRP scores. The studied polymorphism may be a new genetic marker for predicting the severity of AS.
Psoriatic arthritis (PsA) is a chronic inflammatory disease of the group of spondylitides, which is associated with psoriasis. The decisive role is played by the activation of the interleukin (IL)-23/IL-17 axis in the pathogenesis of PsA [1]. Secukinumab (SEC) is a fully human antibody that binds to human IL-17A and neutralizes the activity of this cytokine. That the patient has concomitant diseases, chronic hepatitis B virus infection and hepatitis C viral (HCV) infection in particular, limits the use of tumor necrosis factor- α inhibitors in the treatment of PsA [2, 3]. The paper describes a clinical case that demonstrates the successful treatment with SEC in a patient with PsA and concomitant HCV infection. In addition to the safety aspects of the use of SEC to treat chronic HCV infection, the issues on optimal dosing of the drug are discussed.
ObjectivesTo analyze the rate of remissions in RA pts treated with tocilizumab (TCZ) on self-assessment index.MethodsThe study included 42 RA pts, predominantly female, 86% were RF-positive and, 84% - ACCP-positive, mean age 50,5±3,1 y, mean disease duration 5,6±4,74 y., high disease activity was established in 93% patients. Prior to TCZ all pts were receiving DMARDs, mostly methotrexate at average dose 15,0±2,7 mg/week; 14,3% pts - leflunomide 20 mg/day; 11,9% - sulfasalazine 2 g/day for at least 3 months without any improvement. TCZ 8 mg/kg was administered every 4 weeks during 24 weeks. Treatment outcomes were assessed by patients using RAPID-3, DAS28, CDAI, SDAI.ResultsBefore therapy average RAPID-3 was 15,6 [11,5;18,85]. After first infusion remission by RAPID-3 scale was achieved in 14% patients, at week 12 – in 20,3%, after 16 weeks - in 25%, by week 20 – in 30,5%, by week 24 - in 33,3% patients. After 6 month of TCZ therapy remission or low disease activity was achieved in 61,9% patients. Comparable results in were documented on SDAI (33%), CDAI (31%) and RAPID-3 (33,3%) scales. By week 24 of therapy maximum percentage of remissions was registered by DAS28 (71,4%).ConclusionsRemissions rates on RAPID-3 are similar to SDAI and CDAI, and 2-fold lower than the rates by DAS28 score. The difference in remissions rates is most likely explained by subjective factor in patient's self-assessment using RAPID-3, CDAI and SDAI scales vs physician's oversized assessment of patient's health status using DAS28.Disclosure of InterestNone declared
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