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Научно-практическая ревматология

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Проект рекомендаций по лечению ревматоидного артрита Общероссийской общественной организации «Ассоциация ревматологов России» – 2014 (часть 1)

https://doi.org/10.14412/1995-4484-2014-477-494

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Аннотация

Представлены новые рекомендации Общероссийской общественной организации «Ассоциация ревматологов России» (АРР) по лечению ревматоидного артрита (РА), адаптирующие современную концепцию фармакотерапии этого заболевания – «Лечение до достижения цели». Согласно рекомендациям основная цель фармакотерапии РА – достижение ремиссии (или низкой активности) заболевания. Для реализации этой цели терапия базисными противовоспалительными препаратами (БПВП) должна назначаться всем пациентам с РА как можно раньше, а эффективность терапии – тщательно контролироваться и модифицироваться в зависимости от активности заболевания. Акцентируется внимание на применении метотрексата (МТ) в качестве «золотого стандарта» фармакотерапии РА и ключевого компонента стратегии «Лечение до достижения цели». Раннее назначение МТ (в том числе в форме для подкожного введения) должно стать обязательным компонентом лечения РА на всех стадиях болезни. При недостаточной эффективности или плохой переносимости МТ (включая подкожную форму препарата) или комбинированной терапии МТ и стандартными БПВП следует назначить генно-инженерные биологические препараты (ГИБП), включающие ингибиторы фактора некроза опухоли α, ингибиторы рецепторов интерлейкина 6 (тоцилизумаб), анти-В-клеточные препараты (ритуксимаб) и блокаторы активации Т-лимфоцитов (абатацепт). Терапия тофацитинибом (ингибитор JAK) оправдана у пациентов, резистентных к стандартным БПВП и ГИБП. Все ГИБП и тофацитиниб предпочтительнее применять в комбинации с МТ (или другими БПВП).

Об авторах

Е. Л. Насонов
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия Кафедра ревматологии ГБОУ ВПО «Первый Московский медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Россия
Россия


В. И. Мазуров
ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова», Санкт-Петербург, Россия
Россия


Д. Е. Каратеев
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия
Россия


Г. В. Лукина
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия Городская клиническая больница №1 им. Н.И. Пирогова, Москва, Россия
Россия


Е. В. Жиляев
Городская клиническая больница №1 им. Н.И. Пирогова, Москва, Россия
Россия


В. Н. Амирджанова
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия
Россия


Ю. В. Муравьев
ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия
Россия


Н. В. Чичасова
Кафедра ревматологии ГБОУ ВПО «Первый Московский медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Россия
Россия


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Для цитирования:


Насонов Е.Л., Мазуров В.И., Каратеев Д.Е., Лукина Г.В., Жиляев Е.В., Амирджанова В.Н., Муравьев Ю.В., Чичасова Н.В. Проект рекомендаций по лечению ревматоидного артрита Общероссийской общественной организации «Ассоциация ревматологов России» – 2014 (часть 1). Научно-практическая ревматология. 2014;52(5):477-494. https://doi.org/10.14412/1995-4484-2014-477-494

For citation:


Nasonov E.L., Mazurov V.I., Karateev D.E., Lukina G.V., Zhilyaev E.V., Amirdzhanova V.N., Muraviyov Y.V., Tchichasova N.V. PROJECT: RECOMMENDATIONS ON TREATMENT OF RHEUMATOID ARTHRITIS DEVELOPED BY ALL-RUSSIAN PUBLIC ORGANIZATION «ASSOCIATION OF RHEUMATOLOGISTS OF RUSSIA» – 2014 (PART 1). Rheumatology Science and Practice. 2014;52(5):477-494. (In Russ.) https://doi.org/10.14412/1995-4484-2014-477-494

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