References

mrj

Современная ревматология

Modern Rheumatology Journal

1996-70122310-158X

IMA-PRESS, LLC

10.14412/1996-7012-2014-2-28-34

mrj-547

Research Article

АКТУАЛЬНЫЕ ВОПРОСЫ ТЕРАПИИ РЕВМАТОИДНОГО АРТРИТА

URGENT PROBLEMS IN TREATMENT OF RHEUMATOID ARTHRITIS

Рекомендации EULAR по лечению ревматоидного артрита (2013): использование глюкокортикоидов

EULAR recommendation for the management of rheumatoid arthritis (2013): glucocorticoid use

Чичасова

Н.В.

Chichasova

N.V.

1@ru.ru

ФГБУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой» РАМН, Москва, РоссияРоссияV.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, RussiaRussian Federation

2014

08052014

822834

2014

Чичасова Н.

Chichasova N.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://mrj.ima-press.net/mrj/article/view/547

В статье обсуждается место глюкокортикоидов (ГК) в современной стратегии лечения ревматоидного артрита (РА) согласно рекомендациям EULAR 2013 г. Приведен обзор основных исследований ГК за весь период применения этих препаратов в лечении РА. Обсуждаются сложности, позитивные и негативные стороны использования ГК при РА, возможности их влияния на прогрессирование деструкции в мелких суставах кистей и стоп. В связи с получением в последние годы новых данных рекомендация EULAR 2013 г. по ведению больных РА в отношении ГК сформулирована следующим образом: «В качестве компонента стратегии лечения в течение первых 6 мес болезни следует рассматривать применение низких доз ГК (в комбинации с одним или несколькими базисными противовоспалительными препаратами)». Особо подчеркивается, что ГК следует отменить как можно быстрее, насколько это возможно с клинической точки зрения. Термин «низкая доза ГК» подразумевает назначение преднизолона в дозе ≤7,5 мг/сут.

The role of glucocorticoids (GCs) in the current strategy of treating rheumatoid arthritis (RA) according to the EULAR 2013 recommendation is discussed. The main studies focused on GCs since they started to be used to treat RA are reviewed. The difficulties, advantages, and draw- backs of using GCs to treat RA, as well as possibilities to affect progression of destruction in small joints of the hands and feet, are discussed.

Since new data have recently been obtained, EULAR recommendations 2013 for the management of RA patients states the following for GCs: «The use low doses of GCs (combined with one or several disease-modifying anti-rheumatic drugs) should be considered as a component of the treatment strategy during the first six months of the disease». It is particularly emphasized that GCs should be abandoned as soon as it is pos- sible from the clinical viewpoint. The term «low dose of GC» means prednisolone prescribed at a dose ≤7.5 mg/day.

rheumatoid arthritisglucocorticoidsmanagement of patientsEULAR recommendations.

References1

Conn DL. Resolved: low-dose prednisone is indicated as a standard treatment in patients with rheumatoid arthritis. Arthritis Rheum. 2001;45(5):462–7. DOI: http://dx.doi.org/10.1002/1529-0131(200110)45:5%3C462::AID-ART366%3E3.0.CO;2-V.

Saag KG. Resolved: low-dose glucocorticoids are neither safe nor effective for longterm treatment of rheumatoid arthritis. Arthritis Rheum. 2001;45(5):468–71. DOI: http://dx.doi.org/10.1002/1529-0131(200110)45:5%3C468::AID-ART367%3E3.0.CO;2-A.

Moreland LW, O’Dell JR. Glucocorticoids and rheumatoid arthritis. Back to the future? Arthritis Rheum. 2002;46(10):2553–63. DOI: http://dx.doi.org/10.1002/art.10567.

Conn DL, Lim SS. New role for an old friend; prednisone is a disease-modifying agent in early rheumatoid arthritis. Curr Opin Rheumatol. 2003;15(3):193–8. DOI: http://dx.doi.org/10.1097/00002281-200305000-00004.

Насонов ЕЛ. Лечение ревматоидного артрита: роль глюкокортикоидов. Клиническая медицина. 1999;4:4–8. [Nasonov EL. Lechenie revmatoidnogo artrita: rol' glyukokortikoidov. Klinicheskaya meditsina. 1999;4:4–8. (In Russ.)]

Pincus T, Sakka T, Stein CM. Are longterm very low doses of prednisolon for patients with rheumatoid arthritis as helpful as high doses are harmful? Ann Intern Med. 2002;136(1):76–8. DOI: http://dx.doi.org/10.7326/0003-4819-136-1-200201010-00013.

Bijsma JW, Boers M, Saag KG, Furst DE. Glucocorticoids in the treatment of early and late RA. Ann Rheun Dis. 2003;62(11):1033–7. DOI: http://dx.doi.org/10.1136/ard.62.11.1033.

Hench PS, Kendall EC, Slocumb CH, Polley HF. The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocortisone; compound E) and the pituitary adrenocorticotropic hormone on rheumatoid arthritis. Proc Staff Meet Mayo Clin. 1949;24:181.

Report by the Joint Committee of the Medical Research Council an Nuffield Foundation on Clinical Trials of cortisone? ACTH/ and other therapeutic measures in chronic rheumatic diseases. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis [first report]. Ann Rheum Dis. 1959;18:173–87. DOI: http://dx.doi.org/10.1136/ard.18.3.173.

Report by the Joint Committee of the Medical Research Council an Nuffield Foundation on Clinical Trials of cortisone? ACTH/ and other therapeutic measures in chronic rheumatic diseases. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis [second report]. Ann Rheum Dis. 1960;19:331–7. DOI: http://dx.doi.org/10.1136/ard.19.4.331.

Bollet AJ, Black R, Bunim JJ. Major undesirable effects resulting from prednisolone and prednisone. J Am Med Assoc. 1955;158(6):459–63. DOI: http://dx.doi.org/10.1001/jama.1955.0296006 0017005.

Saag KG, Criswell LA, Sems KM, et al. Low-dose corticosteroids in rheumatoid arthritis: a meta-analysis of their moderateterm effectiveness. Arthritis Rheum. 1996;39(11):1818–25. DOI: http://dx.doi.org/10.1002/art.1780391107.

Wolfe F, Mitchell DM, Sibley JT, et al. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994;37(4):2529–33. DOI: http://dx.doi.org/10.1002/art.1780370408.

Van Gestel AM, Laan RF, Haagsma CJ, et al. Oral steroids as bridge therapy in rheumatoid arthritis patients starting with parenteral gold: a randomized double-blind placebo-controlled trial. Br J Rheumatol. 1995;34(4):347–51. DOI: http://dx.doi.org/10.1093/rheumatology/34.4.347.

Pincus T, Marcum SB, Callahan LF. Long-term drug therapy in rheumatoid arthritis in seven rheumatology ptivat practice: II. Second line drugs and prednisolone. J Rheumatol. 1992;19(12):1885–94.

Caplan L, Russell AS, Wolfe F. Steroids for rheumatoid arthritis: the Honeymoon revisited (once again). Editorial. J Rhematol. 2005;32(10):1863–5.

Gotzsche PC, Johansen HK. Meta-analysis of short-term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis. BMJ. 1998;316(7134):811–8. DOI: http://dx.doi.org/10.1136/bmj.316.7134.811.

Criswell LA, Saag KG, Sems KM, et al. Moderate-term, low-dose corticosteroids for rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 2. Chichester, UK: John Wiley & Sons, Ltd.; 2004.

Gorter SL, Bijlsma H, Cutolo M, et al. Current evidence for the management of rheumatoid arthritis with glucocorticoids:

a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2010;69(6):1010–4. DOI: 10.1136/ard.2009.127332. Epub 2010 May 6.

Smolen J, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69(6):964–75. DOI: 10.1136/ard.2009.126532. Epub 2010 May 5.

Van Everdingen AA, Jacobs JW, Siewertsz van Reesema DR, et al. Low-dose prednosone therapy for patients with early active rheumatoid arthritis: clinical efficacy, diseasemodifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002;136:1–12. DOI: http://dx.doi.org/10.7326/0003-4819-136-1-200201010-00006,

Kirwan JR, Bijlsma JW, Boers M, et al. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database Syst Rev. 2007;(1):CD006356.

Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509. DOI: 10.1136/annrheumdis-2013-204573. Epub 2013 Oct 25.

Buttgereit F, da Silva JA, Boers M, et al. Standartised nomenclature for glucocorticoids dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis. 2002;61(8):718–22. DOI: http://dx.doi.org/10.1136/ard.61.8.718.

Gaujoux-Viala C, Nam JL, Ramiro S, et al. Efficacy of conventional synthetic disease-modifying antirheumatic drugs, glucocorticoids and tofacitinib — a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2014;73(3):510–5. DOI: 10.1136/annrheumdis-2013-204577. Epub 2014 Jan 7.

Bakker MF, Jacobs JW, Welsing PM, et al. Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med. 2012;156(5):329–39. DOI: 10.7326/0003-4819-156-5-201203060-00004.

Swensson B, Boonen A, Albertsson K, et al. Low-dose prednisolone in addition to the initial disease-modifying drug in patients with early active rheumatoid arthritis reduces joint destruction and increase the remission rate: a two-year andomized trial. Arthritis Rheum. 2005;52(11):3360–70. DOI: http://dx.doi.org/10.1002/art.21298.

Landewe RB, Boers M, Verhoeven AC, et al. COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum. 2002;46(2):347–56. DOI: http://dx.doi.org/10.1002/art.10083.

Wassenberg S, Rau R, Steinfeld P, et al. Very low-dose prednisolone in early rheumatoid arthritis etard radiographic progression over two years: a multicenter, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52(11):3371–3380. DOI: http://dx.doi.org/10.1002/art.21421.

Goekoop-Ruiterman YP, De Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BEST study): a randomized, controlled trial. Arthritis Rheum. 2005;52(11):3381–90. DOI: http://dx.doi.org/10.1002/art.21405.

Heimans L, Wevers-de Boer KV, Visser K, et al. A two-step treatment strategy trial in patients with early arthritis aimed at achieving remission: the IMPROVED study. Ann Rheum Dis. 2013 May 28. [Epub ahead of print]. DOI: 10.1136/annrheumdis-20130203243.

De Silva JA, Jacobs JW, Kirwan JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence trial data. Ann Rheum Dis. 2006;65(3):285–93.DOI: http://dx.doi.org/10.1136/ard.2005.038638. Epub 2005 Aug 17.

Hoes JN, Jacobs JW, Boers M, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoids therapy in rheumatic diseases. Ann Rheum Dis. 2007;66(12):1560–7. DOI: http://dx.doi.org/10.1136/ard.2007.072157. Epub 2007 Jul 27.

Ramiro S, Gaujoux-Viala C, Nam JL, et al. Safety of synthetic and biological DMARDs – a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2013;73(3):529-35. DOI: 10.1136/annrheumdis-2013-204575. Epub 2014 Jan 8.

Dixon WG, Bansback N. Understanding the side effects of glucocorticoid therapy: shininh a light on a drug everyone thinks they know. Ann Rheum Dis. 2012;71(11):1761–4. DOI: 10.1136/annrheumdis-2012-202021. Epub 2012 Jul 31.

Volkman ER, Rezai S, Tarp S, et al. We still don’t` know how to taper glucocorticoids in rheumatoid arthritis, and we can do better. J Rheumatol. 2013;40(10): 1646–9. DOI: 10.3899/jrheum.130019.

Насонов ЕЛ, Каратеев ДЕ, Чичасова НВ. Рекомендации EULAR по лечению ревматоидного артрита – 2013: общая харак-

теристика и дискуссионные проблемы. Научно-практическая ревматология. 2013;51(6):609–22. [Nasonov EL, Karateev DE, Chichasova NV. EULAR recommendations for the treatment of rheumatoid arthritis – 2013: general characteristics and disputable problems. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013;51(6):609–22. (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484-2013-609-22.

Van Tuyl LYD, Boers M, Lems WF, et al. Survival, comorbidities and join damage 11 years after COBRA combination therapy trial in early rheumatoid arthritis. Ann Rheum Dis. 2010;69(5):807–12. DOI: 10.1136/ard.2009.108027. Epub 2009 May 17.

Graudal N, Jurgens G. Similar effects of disease-modifying antirheumatic drugs, glucocorticoids, and biologic agents on radiographic progression in rheumatoid arthrits. Meta-analysis of 70 randomized placebocontrolled or drug controlled studies, including 112 comparison. Arthritis Rheum. 2010;62(10):2852–63. DOI: 10.1002/art.27592.

Smolen JS, Aletaha D, Bijsma JWJ, et al. For the T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631–7. DOI: 10.1136/ard.2009.123919. Epub 2010 Mar 9.

Wolfe F, Caplan L, Michaud K. Treatment for rheumatoid arthritis and the risk of hospitalisation for pneumonia: association with prednisone, disease-modifying drugs, anti tumor necrosis factor therapy. Arthrits Rheum. 2006;54(2):628–34. DOI: http://dx.doi.org/10.1002/art.21568.

Crowson CS, Hoganson DD, Fitz-Gibbon PD, Matteson EL. Development and validation of a risk score for serious infection in patients with rheumatoid arthritis. Arthritis Rheum. 2012;64(9):2847–55. DOI: 10.1002/art.34530.

Staa TP, Geusens P, Bijlsma JW, et.al. Clinical assessment of the long-term ris of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006;54(10):3104–12. DOI: http://dx.doi.org/10.1002/art.22117.

Panoulas VF, Douglas KM, Stavropoulos-Kalinoglou A, et al. Long-term exposure to medium-dose glucocortocoid therapy associates with hypertension in patients with rheumatoid arthritis. Rheumatology (Oxford). 2008;47(1):72–5. DOI: http://dx.doi.org/10.1093/rheumatology/kem311.

Чичасова НВ, Владимиров СА, Имаметдинова ГР и др. Функциональные исходы ревматоидного артрита при различных видах противовоспалительной терапии. Научно-практическая ревматология. 2010;48(2):30–6. [Chichasova NV, Vladimirov SA, Imametdinova GR, et al. Functional outcomes of rheumatoid arthritis during various proceduresof anti-inflammatory therapy. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2010;48(2):30–6. (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484-2010-1413.

The authors declare that there are no conflicts of interest present.