Rheumatoid Arthritis

The text of the scientific work on the topic “Modern standards of the pathogenetic therapy of rheumatoid arthritis. EULAR recommendations »

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Current standards for the pathogenetic treatment of rheumatoid arthritis. Recommendations

D.E. Karateev GU Institute of Rheumatology RAMS

Treatment Goals for Rheumatoid Arthritis

• Suppression of articular and extraarticular symptoms

• Prevention of destruction, joint deformation and associated loss of function

• Improving (maintaining) the quality of life

• Increased life expectancy to a population level

The main groups of drugs for the treatment of RA

• Nonsteroidal anti-inflammatory drugs

• Basic anti-inflammatory drugs

– Biological BPVP (biological preparations)

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• The main group of drugs for symptomatic treatment of RA, in efficacy higher than analgesics (evidence category A)

• NSAIDs do not affect the progression of joint damage (evidence category A) and are not prescribed as monotherapy with an established diagnosis of RA

• Different NSAIDs in equivalent doses do not differ in effectiveness, but differ in the frequency of side effects (evidence category A)

• C-NSAIDs are not inferior in effectiveness to N-NSAIDs, but less likely to cause gastrointestinal damage (evidence category A)

• If the patient has risk factors for gastropathy, treatment should be started with C-NSAIDs, if necessary, prescribe proton pump inhibitors (evidence category A)

G l jucocorticoids

• Low doses of HA (Can’t find what you need? Try a literature selection service.

• The main group of drugs for the treatment of RA (evidence category A), the “gold standard” is methotrexate, the other most widely used drugs are leflunomide, sulfasalazine

• Therapy for NSAIDs should begin as early as possible, preferably within 3 months from the onset of symptoms of RA (evidence category B)

• Early use of BPVP improves function and slows down joint destruction (evidence category B)

• The longer the duration of the disease at the time of the first prescription of the NSAIDs, the lower the effectiveness (evidence category A)

• Regular monitoring of RA activity and response to treatment (DAS recommended) improves treatment outcomes (evidence category B)

• Careful monitoring of toxicity is required.

• Treatment for PDVP continues indefinitely, including periods of remission

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Development of agreements on the biological treatment of rheumatic diseases

• 1999 – D. Fürst et al. substantiated the need for consensus on biologicals

• 2000-2001 – EULAR consensus on name blockers

• 2002-2007 – EU LAR consensus on biological products (except for TNF blockers, anakinra, rituximab, abatasept are included)

– On the use of TNF blockers in AS (2003, 2006)

– On the use of rituximab in RA (2007)

Consensus Highlights of 2007 TNF blockers (infliximab, adalimumab, etanercept)

• In most patients, TNF blockers are prescribed in combination with methotrexate, but can also be combined with other 6PVP, such as leflunomide, sulfasalazine (evidence categories A, B)

• TNF blockers can be effective in patients who have not previously received methotrexate and in some patients can be used as the first BPVP (evidence category A, d)

• If necessary, TNF blockers can be used in monotherapy, but the combination with methotrexate is superior to monotherapy with TNF blockers in severity of response to treatment and the effect on radiological progression (evidence category A)

• There is no evidence that any TNF blocker is more effective than other drugs in this group and should be used first

(evidence categories A, B)

2007 Consensus Highlights TNF Blockers (continued)

• The effect of treatment with a TNF blocker should occur within 12 weeks (evidence categories A, B). In case of insufficient effectiveness, a review of the treatment regimen is indicated – increasing the dose of a biological drug, changing an NSAID (evidence category A);

• During long-term therapy with some kind of TNF blocker, the phenomenon of “loss of effect” can be observed, this does not mean that another TNF blocker will also be ineffective, but switching to OTHER TNF blocker is of limited importance (evidence categories B, O)

• In case of intolerance to one of the TNF blockers, the patient may respond to therapy with another drug of this group, but the likelihood of intolerance to the second also increases (evidence categories B, O)

• TNF blockers reliably inhibit the development of an erosive process,

Including And in patients with a weak clinical Effect (evidence category A), but the significance of this for assessing long-term results of treatment is still unclear

• The use of TNF blockers is cost-effective (evidence category O)

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2007 Consensus Highlights TNF Blockers: Security

■ The risk of developing or activating tuberculosis, possibly with an atypical clinic (evidence category C), a screening examination (history, examination, chest x-ray, tuberculin test) is required for each patient (evidence categories B, C, O)

■ The risk of developing serious bacterial infections is slightly increased (evidence category B), the most common locations are skin, soft tissues and joints (category

• There is a possibility of developing opportunistic infections, BUT the frequency of THEM is very low (evidence categories C, d)

■ The combination of different biological products is not recommended due to a significant increase in the risk of serious infections (evidence category A)

• TNF blockers should not be prescribed to patients infected with hepatitis B virus (evidence category C), but they do not worsen the condition of patients and the viral load for hepatitis C (evidence category C and O)

2007 Consensus Highlights TNF Blockers: Security (continued)

• Infusion reactions are observed infrequently in general and rarely are serious (evidence categories A, B, C), treatment is the appointment of glucocorticoids and antihistamines

(categories of evidence B. C)

• Information about the risk of developing malignant neoplasms during therapy with TNF detectors is contradictory due to the increased risk of neoplasms in RA in general, especially lymphomas (evidence category c); a slight increase in the risk of developing solid tumors, including SKIN TUMORS (evidence category C)

• There is no definite evidence of an increase in the rate of progression of congestive heart failure or associated mortality in the treatment with standard doses of infliximab (up to 5 mg / kg body weight) or etanercept, although the use of infliximab at a dose of 10 mg / kg body weight is associated with a risk of worsening patients , especially with NMU classes MUNA

2007 Consensus Rituximab

• Rituximab is used in combination with methotrexate or in monotherapy (evidence categories A, d) with PO 2 INFUSIONS courses of 1000 mg (in some cases 500 mg is possible) with an interval of 2 weeks (evidence category A)

■ Repeated rituximab courses are given no earlier than 16 weeks, usually after 24 weeks (evidence category)

• Rituximab slows down radiological progression in patients with an insufficient response to TNF blockers (evidence category P)

• The effect of rituximab treatment may depend on the presence of a rheumatoid factor – a less distinct effect may be observed in patients negative for rheumatoid factor and anticytrulline antibodies (evidence category O)

• There is no evidence of an increase in the incidence of tuberculosis, serious opportunistic infections and solid tumors during treatment with rituximab RA, but the doctor’s alertness should be maintained (evidence category O)

Rheumatoid arthritis treatment standards of the Ministry of Health of the Russian Federation, bronchial asthma and hypertension treatment site about hypertension

The lungs themselves can also be inflamed, rheumatoid nodules form in them. Next Post Pills for the treatment of gouty arthritis. In about a third of patients, the first symptoms appear in full health, for no apparent reason.

Database Standard hp. The safety control scheme depends on which drugs are prescribed to the patient. He went to the doctors, treated. The synovial membrane is painful, thickened, the skin above the joint is hot, often reddened, and effusion can be determined. There are limitations, a knee sore is very associated with treatment.

When prescribing genetically engineered biological preparations, their intravenous administration is carried out in a specially equipped treatment room under the supervision of a doctor. Pathogenetic drugs methotrexate, sulfasalazine, leflunomide, hydroxychloroquine and glucocorticoids are prescribed by a rheumatologist or on his recommendation. Any disease is easier to prevent than to cure. Often, patients themselves begin to take these medications and believe that they help well. If the patient is sensitive to gluten or dairy products, then the doctor may recommend paleo-diet.

Bronchial asthma and hypertension treatment site about hypertension

A variety of options for the onset of the disease is characteristic. Go shopping, do other errands? Bronchial asthma, as a rule, is observed only where hyperfunction of the right ventricle of the heart developed and caused pulmonary arterial hypertension.

According to current recommendations, for maximum effectiveness of therapy, it should be started during the first weeks from the onset of the first symptoms. Often there is a lesion of the upper cervical and temporomandibular joints. All drugs are administered intravenously.

Mono-oligoarthritis of the knee or shoulder joints, followed by the rapid involvement of small joints of the hands and feet. Among large joints, in the first place in the frequency of involvement are the knee, less often the elbow and ankle. Nonpharmacological treatment methods. With lesions of the periarticular tissue, periarthritis of pain can be the same as with arthritis, but pain is determined by palpation of the periarticular tissue. This is a special regimen that must be observed until the acute symptoms of the disease are stopped.

With gouty arthritis and chondrocalcinosis, crystals of calcium urate and pyrophosphate are found in the synovial fluid. With their professional steps, the standards of modern therapy were introduced, which made it possible to treat in a new way, training efforts are carried out by their efforts, assistance is provided to severe patients. The treatment standards adopted by the international medical community are aimed at controlling joint inflammation. After adoption, uniform standards for the treatment of the disease were developed, which significantly reduced the percentage of complications and facilitated the exchange of experience between clinicians from different countries.

Now, of course, the rehabilitation procedures in hospitals have reached a new level, and we are grateful for this program. Acute monoarthritis of large joints, resembling septic or microcrystalline arthritis. Decryption of tests General blood test. When the patient’s muscles are weak, it is difficult for them to receive a large load immediately. More recently, a new drug tofacitinib has appeared, which is prescribed in the form of tablets, but in action is close to genetic engineering biological drugs.

When treating bronchial asthma, the doctor must be very attentive and sensitive to the patient’s personality, the right side of the lower back hurts while constantly varying the amount of poison and the time of its use. Certain preference may be given to etanercept and abatacept. A whole system of such control has been developed. Moderate severe periarticular widespread osteoporosis.

Slight narrowing of the joint spaces in individual joints. What modern drugs and methods are used? If the patient has dentures, they must be removed.

Mz rb protocols for the treatment of rheumatoid arthritis

The goal of treatment is to achieve persistent clinical remission or an alternative goal of at least a persistently low disease activity, which ensures stabilization of the patient’s functional capabilities, maintaining the quality of life and working capacity. To improve tolerance of treatment or to achieve a more rapid effect, it is recommended to use a subcutaneous dosage form of methotrexate. The definition of the treatment method for rheumatoid arthritis directly depends on the stage of the identified pathology, is sick and also the presence of complications and the likelihood of an unfavorable prognosis.

Bronchial asthma and hypertension treatment

If anaphylactic shock occurred during intravenous drip of an allergen drug, the needle is left in the vein and drugs are injected through it. With a very high activity of the disease, pulse therapy can be used to administer a high dose of hormones intravenously to relieve exacerbation. Proven genetic predisposition. If there are contraindications for the use of methotrexate or poor tolerance of treatment, the appointment of leflunomide or sulfasalazine is possible.

A hypothetical etiological factor damages the synovial membrane of the joint, a local immune response develops, and altered aggregated IgG is produced by synovial plasma cells. Abrupt climate change, trips to the sea are unacceptable. Among the environmental factors, the role of bacterial stomatogenic and viral infections is discussed, a specific role is given to chemicals, stress, and occupational hazards.

The diet alone cannot cure rheumatoid arthritis. Related diseases and their treatment Descriptions of diseases Rheumatoid arthritis. The main types of inflammatory polyarthritis are rheumatoid arthritis, arthritis in systemic lupus erythematosus, viral arthritis, etc. Allergies, bronchial asthma, hypertension, impotence, arthritis, kidney stones, weight loss. The role of biological agents in the modern treatment of childhood arthritis is indispensable, as they give a quick and pronounced clinical effect and stop the destruction of the joint.

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  • The survey is not duplicated if it was performed at the previous stage as an outpatient or inpatient.
  • Cancellation of immunosuppressants in most patients causes an exacerbation of the process.
  • Treatment of bronchitis, accompanied by complications, is carried out in pulmonology.
  • Consultation of an ophthalmologist.

Transmitted infections, injuries, hypothermia can provoke the development of the disease. For them, it is advisable to conduct an experienced specialist in rehabilitation. The disease begins with pain and swelling of the joints, stiffness of movements in the morning, deposition of salts in the joints of temperature rises. All immunostimulating therapy can cause disease progression. Evidence levels of confidence with an indication of the classification of evidence levels used.

Associated diseases and their treatment

Treatment of stroke and hypertension with pine cones. Pain is always observed at rest and during movement. To do this, it is necessary to suppress the inflammatory process, relieve pain, prevent exacerbations and complications. The disease is characterized by a persistent course, it is difficult to treat without eliminating food allergens. It is carried out at the site of anaphylactic shock.

Clarithromycin mg, mg tab. But in the region, these complex issues are being addressed. Multiple pronounced bone deformities. Previous Post Treatment of arthritis with Saki mud. Anti-rheumatic drugs.

Database

No analysis alone can confirm the diagnosis of rheumatoid arthritis. Treatment should be strictly individualized. The most active of the basic anti-inflammatory drugs are methotrexate, which usually begins the treatment of rheumatoid arthritis. It has also been proven that smoking increases the risk of developing rheumatoid arthritis. An international standard for the diagnosis of rheumatoid arthritis was proposed in the year by the European League for the Control of Rheumatic Diseases.

But it guarantees a reduction in joint inflammation and prevents the manifestation of many symptoms. Patients do not always seek medical help for various reasons. Additional immunological characteristics. The examination includes the studies necessary for making a diagnosis, identifying signs of an exacerbation of the disease, determining the rate of progression of the disease and consists of a mandatory and additional volume.

Treatment Standards for Children with Rheumatoid Arthritis

All genetically engineered biologics and tofacitinib can reduce infection resistance. Gradually, such a regimen will become the norm, the patient’s rheumatoid joints adapt. Bend down to pick up fallen clothes from the floor? The formation of immune complexes also contributes to platelet aggregation, the formation of microthrombi, and disturbances in the microcirculation system.

Standards for the examination and treatment of rheumatological patients

STANDARDS FOR EXAMINATION AND TREATMENT

M02. Reactive Arthropathies

Duration of inpatient treatment: 10-12 days

(diagnostics, specialist consultation)

Consultation of an ophthalmologist

General blood analysis

General analysis of feces

Urine analysis according to Nechiporenko, bacteriological studies

RW glucose urea creatinine ALT AST blood bilirubin

CRP seromucoid fibrinogen RF total protein and its fractions

Instrumental and other research methods

X-ray and or chest graphy

ECG, pelvic ultrasound

X-ray of the iliac-sacral joints

Nonsteroidal anti-inflammatory drugs

General condition improvement;

Increased volume of active movements;

Joint Pain Relief

± – carried out according to indications

M05-M14. Inflammatory polyarthropathy

Seropositive Rheumatoid Arthritis

Seronegative Rheumatoid Arthritis

Duration of inpatient treatment: 10-12 days

(diagnostics, specialist consultation)

Physical therapy consultation

General blood analysis

General analysis of feces

RW glucose urea creatinine ALT AST blood bilirubin

CRP seromucoid fibrinogen RF total protein and its fractions

Instrumental and other research methods

X-ray and or chest graphy

Analgesic and NSAIDs

Basic anti-inflammatory drugs

Disease Modifying Antirheumatic Drugs (MBARP)

Reduction (absence) of pain, swelling of the joints;

Increase (restoration) of the range of motion in the joint;

Improvement (normalization) of laboratory indicators;

± – carried out according to indications

M07 * Psoriatic and enteropathic arthropathies

Duration of inpatient treatment: 10-12 days

(diagnostics, specialist consultation)

General blood analysis

General analysis of feces

RW glucose urea creatinine ALT AST blood bilirubin

CRP seromucoid fibrinogen RF total protein and its fractions

Instrumental and other research methods

X-ray and or chest graphy

Analgesic and NSAIDs

Basic anti-inflammatory drugs

Disease Modifying Antirheumatic Drugs (MBARP)

Reduction (absence) of pain, swelling of the joints;

Increase (restoration) of the range of motion in the joint;

Improvement (normalization) of laboratory indicators;

± – carried out according to indications

M11. Crystalline arthropathy

Duration of inpatient treatment: 10-12 days

Consultation of a doctor – urologist

General blood analysis

General analysis of feces

Uric acid in serum and daily

RW glucose urea creatinine ALT AST blood bilirubin

CRP, seromucoid, fibrinogen, RF, total protein and its fractions

Instrumental and other research methods

X-ray or chest graph

Analgesic and NSAIDs

· Decreased uric acid concentration;

· Reduced need for NSAIDs, colchicine and HC;

Reducing the frequency of gouty attacks leading to disability

± – carried out according to indications

M15,0-M19,0 Osteoarthrosis ((M15,0-M19,0))

Consultation of a doctor – urologist

General blood analysis

General analysis of feces

RW. uric acid in blood serum and in daily urine

Glucose Urea Creatinine ALT AST Blood Bilirubin

CRP, seromucoid, fibrinogen, RF, total protein and its fractions

Coagulation time, coagulogram,

Instrumental and other research methods

X-ray or chest graph

Analgesic and NSAIDs

Clinical criteria for improving the patient’s condition:

General condition improvement;

Increased volume of active movements;

Joint Pain Relief

± – carried out according to indications

M45 Ankylosing seronegative spondylitis

M46 Other inflammatory spondylopathy

Duration of inpatient treatment: 10-12 days

(diagnostics, specialist consultation)

Consultation of a doctor – urologist

General blood analysis

General analysis of feces

RW. glucose urea creatinine ALT AST blood bilirubin

CRP seromucoid fibrinogen RF total protein and its fractions

Instrumental and other research methods

X-ray and or chest graphy

X-ray of the iliac-sacral and costal sternal joints

Analgesic and NSAIDs

Basic anti-inflammatory drugs

Disease Modifying Antirheumatic Drugs (MBARP)

Reducing pain and inflammation in the joints and spine, improving the function of the joints, spine and internal organs;

± – carried out according to indications

M30-M36. Systemic connective tissue lesions

M30. Polyarteritis nodosa and related conditions

Duration of inpatient treatment: 10-12 days

Consultation of a doctor – nerve pathologist

General blood analysis

General analysis of feces

RW glucose urea creatinine ALT AST blood bilirubin

CRP, seromucoid, fibrinogen, RF, total protein and its fractions

coagulation time, coagulogram, lipid spectrum prothrombin index

Instrumental and other research methods

X-ray or chest graph

Analgesic and non-steroidal anti-inflammatory drugs

Hormones and their analogues

Blood coagulation agents

Stabilization of the pathological process (joints, internal organs);

Reverse development of trophic disorders;

Decreased clinical activity of the disease;

± – carried out according to indications

M31 Necrotizing vasculopathies

Aortic arch syndrome (Takayasu)

Duration of inpatient treatment: 10-12 days

Consultation of a doctor – dermatologist,

Consultation with a nerve pathologist

General blood analysis

General analysis of feces

RW glucose urea creatinine ALT AST blood bilirubin

CRP, seromucoid, fibrinogen, RF, total protein and its fractions

coagulation time, coagulogram, lipid spectrum

Instrumental and other research methods

X-ray or chest graph

Analgesic and non-steroidal anti-inflammatory drugs

Hormones and their analogues

Blood coagulation agents

Stabilization of the pathological process (joints, internal organs);

Reverse development of trophic disorders;

Decreased clinical activity of the disease;

± – carried out according to indications

M101 ACUTE RHEUMATIC FEVER

Consultation of a doctor – nerve pathologist

General blood analysis

General analysis of feces

RW. glucose urea creatinine ALT AST blood bilirubin

CRP, seromucoid, fibrinogen, RF, total protein and its fractions

coagulation time, coagulogram, prothrombin index

Instrumental and other research methods

X-ray or chest graph

Etiotropic (antistreptococcal) therapy:

Pathogenetic (anti-inflammatory) therapy:

Therapy of congestive heart failure:

OUTCOME OF TREATMENT AND FORECAST:

Clinical criteria for improving the patient’s condition:

Elimination of inflammation activity, normalization of clinical symptoms;

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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