The article describes the clinical observation of the onset of polyarthritis after COVID-19. Clinical data, laboratory tests' and instrumental methods results in dynamics, as well as approaches to therapy are presented. The discussion reflects modern views on the causes of the development of articular syndrome after SARS-CoV-2, with special attention to the need for a careful study of the history, clinical and laboratory data of patients with COVID-19.
Objectives To assess efficacy and tolerability of infliximab (INF) in patients (pts) with RA depending on the presence of antibodies to INF (ATI) in the serum. Methods Twenty-two pts with active RA despite methotrexate therapy (19 women, mean age 45,8 years, mean disease duration 9,2 years, RF-positive 17, mean CRP 22 mg/L, mean HAQ 1,5, mean DAS28 6) were treated in one center with INF (3 mg/kg intravenously at weeks 0, 2, 6 and every 8 weeks thereafter). Pts were assessed by EULAR criteria at weeks 0, 14 and 22; ATI were measured by TNFα-Bloker-ADA ELISA kit (Immunodiagnostik AG, Germany) at the same points. Correlations between clinical results and the presence of ATI were analyzed. Results Before INF treatment no pt had ATI. Twenty pts completed the study. By the 22-nd week ATI were detected in 7 pts. Among them good results were registered in 2 pts; moderate results, 2 pts; no effect, 3 pts. Thirteen pts had no serum ATI. In this group clinical effect was assessed as good in 5 pts, and as moderate in 8 pts. No poor effect was noted among these pts. Positive (good and moderate) results were achieved in pts without ATI significantly more often (p=0,035). Frequency of adverse events was the same in both groups. Conclusions Presence of ATI can be considered as a risk factor for the reduction of the INF clinical effect. Disclosure of Interest None Declared
Background and objectives Abatacept (ABA) is a selective co-stimulation modulator. ABA is widely used in treatment of RA. There isn’t enough data about the effectiveness of ABA at different stages of RA. Objectives To compare effect of ABA in patients (pts) with early (ERA) and long-standing (LS) RA. Materials and methods Eighty patients with early (less than three years duration, 51%) and LS (more than three years duration, 49%) RA and an inadequate response to synthetic DMARDs or biologics (adalimumab, rituximab, tocilizumab) were enrolled in the study. Most of them were women, age 49 ± 13 years, with a high disease activity (DAS28=5,28 ± 1,1), RF-positive (75.7%) and ACPA-positive (75%). Disease activity was assessed by DAS28. Results were assessed every 12 weeks according to EULAR criteria. Results Before treatment in patients with early RA DAS28 was 5.26 ± 0.89, with long-standing RA - 5,3 ± 1,3. After 3 months of therapy good and moderate response by EULAR criteria was achieved in 82.2% in the group of ERA and in 67.5% of patients with LS RA (p < 0.05). There was no significant difference in achieving good EULAR response between two groups after 3 months (26.47% - ERA; 25.7% - LS RA) and 6 months of therapy (31.9% - ERA; 35.2% - LS RA). The number of non-responders in pts with LS RA was significantly higher both after 3 months and 6 months (32.35% and 25.3%) as compared to pts with ERA (17.6% and 17.02% respectively). 25 adverse events (AE) in 19 (23%) pts were registered. The most frequent AE were upper respiratory tract infections - 8 pts. One pt has herpes zoster and one, abscess of the right thumb. Conclusion Abatacept has shown significant improvement in reduction of disease activity in pts with an inadequate response to previous therapy. There was no significant difference in achieving good EULAR response between pts with early and LS RA. There were more patients with an inadequate response to ABA in the LS RA group. ABA was well tolerated, AE were registered only in 23% of patients. ABA is an effective drug with a good safety profile. ABA has found its niche in the treatment of both LS and ERA.
Objective: to assess the time course of changes in the concentration of methotrexate (MTX) and its main metabolites in the red blood cells (RBC) and mononuclear cells (MNC) of patients with rheumatoid arthritis (RA), by taking into account individual characteristics (age, statin therapy, and smoking).Patients and methods. The investigation enrolled 33 MTX-treated patients (mean age 53.2±11.7 years) with RA, who underwent therapeutic drug monitoring to measure the RBC and MNC concentrations of free MTX and MTX polyglutamates (MTXPGs) with 2, 3, and 4 glutamate residues (MTXPG 2–4) in using tandem chromatomass spectrometry after 4, 12, and 24 weeks of therapy.Results and discussion. Following 12 weeks, the concentration of MTXPG4 in the MNC was higher in patients taking statins, while that of MTX and MTXPG2 in the RBC were significantly lower than in smokers. At 24 weeks, older patients were observed to have a higher MTX level and a lower MTXPG4 concentration in the RBC.Conclusion. After 24 weeks of therapy, the RBC concentration of MTPG4 was lower and that of MTX was higher in older patients than in others, which confirms data on a slower MTX metabolism in the elderly. The use of statins is likely to have a positive impact on the accumulation of MTXPG. There is a statistically significantly lower RBC concentration of MTXPG in at 12 weeks of therapy.
Introduction. In modern reality postcovid syndrome (PCS) is characterized by clinical heterogeneity and multi-organ involvement, often presenting a differential diagnostic and therapeutic problem. However, in most studies of PCS, stratification of patients taking into account individual comorbid conditions was not performed. Thus, only an extremely small number of studies have been devoted to assessing the course of PCS in rheumatic diseasesPurpose. To characterize the features of the course of COVID-19 in patients with rheumatoid arthritis, as well as to conduct a comparative assessment of clinical and demographic parameters in groups of patients with rheumatoid arthritis, differentiated by the presence of PCS.Materials and methods. The material of the questionnaire which contained questions regarding socio-demographic data of respondents, information on rheumatological history, comorbid diseases, data on past COVID-19, including cases of re-infection, and PCS.Results.The study included 32 adult patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis. Of the 32 patients who underwent COVID-19, in 23 cases it was possible to form a judgment about the presence or absence of PCS. To study PCS, 23 patients were stratified into two groups: 11 (47.8%) patients developed PCS (Group 1) and 12 patients had COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). In the general group 37.5% of patients with COVID-19 required inpatient treatment. The number of symptoms associated with COVID-19 did not correlate with RA activity, however, patients with higher RA activity were more likely to report increased arthralgia as a symptom of COVID-19. 47.8% of COVID-19 survivors experienced PCS. The average age, the number of comorbid diseases and the severity of RA symptoms at the time of COVID-19 were relatively higher in the group of patients with RA and PKS. Patients with PKS also noted a higher frequency of hospitalizations and a more severe course of COVID-19.Conclusions. A quantitative assessment of the risk of developing PKS is needed, which will serve as a basis for developing a strategy aimed at prevention, timely diagnosis and treatment of this syndrome in patients with RS. To this end, further studies on larger cohorts of patients are required.
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