References

mrj

Современная ревматология

Modern Rheumatology Journal

1996-70122310-158X

IMA-PRESS, LLC

10.14412/1996-7012-2014-2-15-20

mrj-553

Research Article

АКТУАЛЬНЫЕ ВОПРОСЫ ТЕРАПИИ РЕВМАТОИДНОГО АРТРИТА

URGENT PROBLEMS IN TREATMENT OF RHEUMATOID ARTHRITIS

Оценка активности заболевания при ревматоидном артрите: рекомендации и практика

Assessment of disease activity in rheumatoid arthritis: recommendations and practice

Олюнин

Ю.А.

Olyunin

Yu.A.

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

821520

2014

Олюнин Ю.

Olyunin Y.

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/553

Результаты исследований, проведенных за последние два десятилетия, стали основой для разработки рекомендаций EULAR по ле- чению ревматоидного артрита (РА), обновленный вариант которых был недавно опубликован. В соответствии с этими рекомендациями тактика ведения больного в каждом конкретном случае зависит в первую очередь от имеющегося у него уровня активности болезни. Этот показатель определяет частоту осмотров пациента, выбор противорев- матического препарата и необходимость коррекции терапии. Пациентам с активным РА (с высокой или умеренной активно- стью), не получавшим ранее базисных противовоспалительных препаратов (БПВП), показано назначение метотрексата. При более низкой активности может быть использован другой БПВП. Эффективность терапии оценивается уже через 3 мес после ее назначения. К этому времени должно быть достигнуто клиническое улучшение, которое определяется как снижение актив- ности РА с высокой до умеренной. Однако целью терапии является не просто клиническое улучшение, а низкая активность забо- левания или ремиссия, которая должна быть достигнута не позднее чем через 6 мес после начала лечения. Если максимальная до- за препарата не позволяет достичь клинического улучшения через 3 мес и низкой активности через 6 мес, следует рассмотреть вопрос о коррекции терапии. Для определения уровня активности РА эксперты EULAR рекомендуют использовать суммарные индексы, включающие показате- ли суставного счета (DAS28, SDAI или CDAI).

The results of studies conducted over the past two decades were used to elaborate EULAR recommendations for the management of rheumatoid arthritis (RA); the updated recommendations have recently been published.

In accordance with these recommendations, the tactics in management of each patient is determined by the disease activity. This indicator determines the frequency of examination for the patient, selection of an anti-rheumatic drug, and the need for therapy correction. Methotrexate is recommended to patients with active RA (high or moderate activity) naÏve to disease-modifying anti-rheumatic drugs (DMARDs). Another DMARD can be used for patients with lower activity of RA. Therapy effectiveness is evaluated as soon as 3 months after its prescription.

Clinical improvement (decrease in RA activity from high to moderate) needs to be achieved by this time. However, the aim of therapy is to achieve low disease activity or remission (that needs to be achieved earlier than 6 month after the therapy was started) rather than clinical improvement only. If the maximum dose of a drug results neither in clinical improvement after 3 months nor in low activity after 6 months, the therapy should be corrected. EULAR experts recommend using the overall score that includes joint score indices (DAS28, SDAI or CDAI) to assess the level of RA activity.

ревматоидный артритопределение активности ревматоидного артритарекомендации EULAR.

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