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Interleukin 6 Receptor Inhibitor Levilimab in the Treatment of Rheumatoid Arthritis 白细胞介素6受体抑制剂来利单抗治疗类风湿关节炎
Pub Date : 2022-06-18 DOI: 10.33978/2307-3586-2022-18-18-6-10
D. Karateev, E. Luchikhina
The inhibitors of the biological effects of interleukin 6 (IL-6) are the most actively developing group of biologics for the treatment of rheumatoid arthritis (RA) due to pleiotropic effects of this most important pro-inflammatory cytokine, which stimulates a number of processes that play an important role in the pathogenesis of RA. IL-6 receptor (IL-6R) is of great importance in the implementation of these biological effects. Activation of IL-6R occurs with the participation of the glycoprotein gp130 in three variants: classical, and in trans-signaling and trans-presentation modes. The most recent representative of this group is levilimab, an IgG1 monoclonal antibody to IL-6R that binds both soluble and membrane forms of the receptor. The efficacy and safety of levilimab has been demonstrated in the Phase II AURORA and Phase III SOLAR trials. The paper presents the main statements of the resolution of the regional expert council of rheumatologists of Moscow and the Moscow Region on the topic: ‘The place of a new IL-6R inhibitor levilimab in the treatment of patients with rheumatoid arthritis’, which took place on December 18, 2021 in Moscow. The panel of experts confirmed that levilimab is recommended for widespread use in patients with active RA who fail or are intolerant to traditional synthetic DMARDs.
白细胞介素6 (IL-6)的生物效应抑制剂是治疗类风湿性关节炎(RA)的最活跃的生物制剂组,因为这一最重要的促炎细胞因子具有多效性,它刺激了许多在RA发病机制中起重要作用的过程。IL-6受体(IL-6R)在这些生物学效应的实现中起着重要作用。IL-6R的激活与糖蛋白gp130的参与在三种变体中发生:经典、反式信号传导和反式递呈模式。这一组的最新代表是levilimab,一种针对IL-6R的IgG1单克隆抗体,可结合可溶性和膜形式的受体。利来单抗的有效性和安全性已在II期AURORA和III期SOLAR试验中得到证实。该文件介绍了莫斯科和莫斯科地区风湿病专家委员会关于主题的主要声明:“新型IL-6R抑制剂levilimab在治疗类风湿性关节炎患者中的地位”,该决议于2021年12月18日在莫斯科举行。专家小组确认,利来单抗被推荐广泛用于对传统合成dmard无效或不耐受的活动性RA患者。
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引用次数: 0
Practical Guidelines for Radiological Investigation Methods in Rheumatoid Arthritis and Ankylosing Spondylitis 类风湿关节炎和强直性脊柱炎放射检查方法实用指南
Pub Date : 2022-06-18 DOI: 10.33978/2307-3586-2022-18-18-12-25
D. Karateev, E. Stepanova, E. Luchikhina
Radiological examination remains the "gold standard" for instrumental diagnosis of the most common immunoinflammatory rheumatic diseases – rheumatoid arthritis (RA) and ankylosing spondylitis (AS). This publication discusses the indications and methodological aspects of performing standard radiography of the musculoskeletal system in RA and AS. It also describes the main radiological symptoms, methods for assessing the staging of the disease (according to O. Steinbrocker and J. Kellgren), methods for assessing radiological progression: in RA – according to J.T. Sharp/D.M. van der Heijde and A. Larsen, in AS – mSASSS, RASSS, BASRI.
放射学检查仍然是最常见的免疫炎性风湿病——类风湿关节炎(RA)和强直性脊柱炎(AS)——仪器诊断的“金标准”。本出版物讨论了RA和AS中执行肌肉骨骼系统标准x线摄影的适应症和方法学方面。它还描述了主要的放射学症状,评估疾病分期的方法(根据O. Steinbrocker和J. Kellgren),评估放射学进展的方法:在类风湿性关节炎中-根据J. t . Sharp/D.M.van der Heijde和A. Larsen, in AS - mSASSS, RASSS, BASRI。
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引用次数: 0
Modern Approaches to the Diagnosis and Therapy of Reactive Arthritis 反应性关节炎的现代诊断和治疗方法
Pub Date : 2022-06-18 DOI: 10.33978/2307-3586-2022-18-18-26-33
B. Belov, N. V. Muravyova, S. Erdes
Currently, the problem of reactive arthritis (ReA) remains important. This is due to the sufficiently high prevalence of the disease. The analysis of epidemiological data allows us to put forward a number of possible reasons explaining the different frequency of ReA in certain regions of the Russian Federation and in other countries. The article details the clinical picture of the disease, analyzes the significance of various laboratory techniques aimed at identifying the causative agent of ReA. The main approaches to the therapy of ReA, including the use of antimicrobial drugs, are described.
目前,反应性关节炎(ReA)的问题仍然很重要。这是由于该病的流行率非常高。对流行病学数据的分析使我们能够提出一些可能的原因,解释俄罗斯联邦某些地区和其他国家ReA发病率不同的原因。本文详细介绍了该病的临床表现,分析了各种实验室技术对确定ReA病原体的意义。介绍了治疗ReA的主要方法,包括抗菌药物的使用。
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引用次数: 0
Spa Treatment of Children with Congenital Epidermolysis Bullosa 小儿先天性大疱性表皮松解症的水疗治疗
Pub Date : 2022-05-30 DOI: 10.33978/2307-3586-2022-18-16-20-23
I.L. Zakhartsova, V. D. Ostapishin
Epidermolysis bullosa (EB) belongs to the group of genetically and clinically heterogeneous diseases characterized by the formation of blisters and erosions on the skin and mucous membranes, vulnerability and sensitivity of the skin to minor mechanical injury (mechanobullous disease). According to unconfirmed reports, there are 2-2.5 thousand children with congenital epidermolysis in Russia. There are no radical methods of treatment for any form of EB. All therapeutic measures are palliative, aimed primarily at preventing injuries and blisters arising on their background with the help of optimal skin care and affected areas. Since 2018, in the ‘Avangard’ Sanatorium of the Branch of ‘Children's Medical Center’ the Federal State Budgetary Institution of the Administration of the President of RF in Sochi, within the framework of cooperation with the ‘Butterfly Children’ Charity Foundation, children with congenital epidermolysis receive rehabilitation and spa treatment. Individual treatment programs and psychological assistance specially developed for children are aimed at preventing the occurrence of new rashes, regression of vesicular and erosive-ulcerative rashes, improving the quality of life of patients. During our work with such children, we have managed to achieve certain results in treatment and rehabilitation. Spa treatment of children with congenital BE is an integral part of comprehensive treatment.
大疱性表皮松解症(Epidermolysis bullosa, EB)属于一组遗传和临床异质性疾病,其特征是皮肤和粘膜形成水泡和糜烂,皮肤对轻微机械损伤(机械大疱性疾病)易感性和敏感性。根据未经证实的报告,在俄罗斯有2- 2500名先天性表皮松解症儿童。对于任何形式的EB都没有根治性的治疗方法。所有治疗措施都是姑息性的,主要目的是在最佳皮肤护理和受影响区域的帮助下,防止在其背景上产生伤害和水泡。自2018年以来,在索契联邦总统行政联邦国家预算机构“儿童医疗中心”分院的“Avangard”疗养院,在与“蝴蝶儿童”慈善基金会合作的框架内,先天性表皮松解症儿童接受康复和水疗治疗。专门为儿童制定的个体化治疗方案和心理援助,旨在预防新发皮疹的发生、水疱性和糜烂性溃疡性皮疹的消退,提高患者的生活质量。在我们为这些儿童工作期间,我们设法在治疗和康复方面取得了某些成果。小儿先天性BE的水疗治疗是综合治疗的重要组成部分。
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引用次数: 0
Ebstein's Anomaly 原发异常
Pub Date : 2022-05-30 DOI: 10.33978/2307-3586-2022-18-16-14-19
V. Delyagin, N. Doctorova, I.Ye. Belokrinitskaya
Ebstein’s anomaly is a rare congenital malformation characterized by apical displacement of the right atrioventricular ring with an anomaly of the development of the tricuspid valve and the frequent presence of other heart defects. According to our data, this defect was diagnosed in 2 cases in more than 6 000 sectional studies: in an adult and a child. According to the echocardiography rooms of non-specialized multidisciplinary children's hospitals and children's polyclinics, the defect is detected with a frequency of 1:24.000–1:32.000 studies. Genetic and environmental factors (viral infections, benzodiazepines, lithium) are indicated as probable causes. Clinical signs are cyanosis, shortness of breath, heart failure, cardiac arrhythmias. Morphologically there are abnormalities of the tricuspid valve, papillary muscles and chordal apparatus, right ventricular myocardial hypertrophy, thinning of the walls of the right atrium and atrialized part of the right ventricle. Decisive for the diagnosis is ultrasound. Displacement of the right atrioventricular ring is revealed. The degree of bias determines the severity of the defect. The amplitude of the tricuspid valve movement is increased. Its valve closure occurs later than the mitral. A 40 ms difference between the tricuspid and mitral valve closure points is a diagnostically important sign of Ebstein’s anomaly. The tactics of a doctor are determined by the clinical picture
Ebstein畸形是一种罕见的先天性畸形,其特征是右房室环顶端移位,伴有三尖瓣发育异常,并经常出现其他心脏缺陷。根据我们的资料,在超过6 000个断面研究中诊断出2例这种缺陷:一名成人和一名儿童。根据非专业多学科儿童医院和儿童综合诊所的超声心动图室,该缺陷的检测频率为1:24 000 - 1:32 000。遗传和环境因素(病毒感染、苯二氮卓类药物、锂)被认为是可能的原因。临床表现为发绀、呼吸短促、心力衰竭、心律失常。形态学上表现为三尖瓣、乳头肌和索索器官异常,右心室心肌肥厚,右心房壁变薄,右心室部分心房化。超声是诊断的决定性因素。显示右房室环移位。偏差的程度决定了缺陷的严重程度。三尖瓣运动幅度增大。它的瓣膜关闭晚于二尖瓣。三尖瓣和二尖瓣关闭点之间40毫秒的差异是Ebstein异常的重要诊断标志。医生的策略是由临床情况决定的
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引用次数: 1
Resort Pediatrics 度假胜地儿科
Pub Date : 2022-05-30 DOI: 10.33978/2307-3586-2022-18-16-24-26
V. D. Ostapishin
The group of frequently ill children includes children who respiratory disease more 6 times per year or more frequently than once per month during the period of maximum incidence from October to March. In Russia the share of frequently ill children in the general population ranges from 15 to 75%, of whom two-thirds are children aged 3 to 6 years. In this regard, schemes of innovative restorative treatment are becoming particularly relevant, allowing to increase the effectiveness of rehabilitation of children and strengthen the adaptive capabilities of the body.
经常患病的儿童包括每年呼吸道疾病6次以上或在10月至3月的最高发病率期间每月呼吸道疾病次数多于一次的儿童。在俄罗斯,经常患病的儿童占总人口的比例在15%至75%之间,其中三分之二是3至6岁的儿童。在这方面,创新的恢复性治疗方案正变得特别重要,可以提高儿童康复的效力并加强身体的适应能力。
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引用次数: 0
Features of the Immune Response and the Possibility of Correcting the Maladaptation of the Immune Response in Patients with Acute Respiratory Viral Infections from Organized Groups 急性呼吸道病毒群体感染患者免疫反应特点及纠正免疫反应不适应的可能性
Pub Date : 2022-05-30 DOI: 10.33978/2307-3586-2022-18-16-8-13
V. Akimkin, Z. Ponezheva, L. O. Ponezheva, T. S. Guseva, O. Parshina, A. N. Turapova
The purpose of the study was to determine the severity of maladaptation disorders of the immune response and the possibility of their correction in patients with acute respiratory viral infections from organized groups. Material and methods. 90 patients with uncomplicated forms of ARVI and a group of conditionally healthy (n = 30) from organized groups were examined. In addition to symptomatic therapy, patients received a combination of rectal and intranasal forms of recombinant IFN-α-2b. Identification of the ARVI pathogen was determined by PCR. ELISA was used to determine serum concentrations of IFN-α and IFN-γ and the ability of blood cells to produce these cytokines ex vivo spontaneously and when stimulated by Newcastle disease virus or phytohemagglutinin. Flow cytometry was used to analysis the subpopulation composition of peripheral blood lymphocytes. The study of the levels of secretory IL-8, IgA, serum IL-8 was carried out by enzyme immunoassay. Results. The etiology of ARVI was deciphered in 62.1% of patients, the main share in the morbidity structure was due to influenza (39.3%) and adenoviruses (35.6%). In the first 3 months of the formation of organized teams in apparently healthy people, a decrease in the level of T-helpers, natural killers and inhibition of the interferon system was revealed, which indicates a violation of adaptive mechanisms and contributes to a decrease in body resistance. An analysis of the cytokine system showed an increase in the concentration of secretory and serum IL-8 in patients with acute respiratory viral infections compared with a group of practically healthy people. In the immune status 1 month after ARVI, there was a significant increase in the number of T-lymphocytes, T-helpers with a tendency to normalize T-lymphocytes carrying IFN-α and -γ receptors, while maintaining a significantly reduced number of B-lymphocytes. The immunomodulatory efficacy of combination therapy with recombinant IFN-α-2b is characterized by an increase in the amount of induced IFN-α during its initial depression and a decrease in initial hyperproduction. Also, at the initial level of induced IFN-α less than 200 pg/ml, there was an increase in the concentration of secretory IL-8 and IgA. Conclusion. In conditionally healthy individuals, in the first 3 months of the formation of organized groups, maladjustment disorders in the immune response were detected in 34% of cases. The interferon-modulating effect of combination therapy with recombinant IFN-α-2b was shown.
本研究的目的是确定急性呼吸道病毒感染患者免疫反应适应不良障碍的严重程度及其纠正的可能性。材料和方法。从组织组中选取90例无并发症ARVI患者和一组条件健康患者(n = 30)进行检查。除了对症治疗外,患者还接受了直肠和鼻内重组IFN-α-2b的联合治疗。采用PCR法鉴定ARVI病原菌。ELISA法测定血清中IFN-α和IFN-γ的浓度,以及细胞在体外自发和受新城疫病毒或植物血凝素刺激时产生这些细胞因子的能力。采用流式细胞术分析外周血淋巴细胞亚群组成。采用酶免疫法检测各组血清IL-8、IgA、IL-8水平。结果。62.1%的ARVI患者病因明确,在发病结构中主要由流感(39.3%)和腺病毒(35.6%)引起。在看似健康的人组成有组织的团队的前3个月,发现t辅助细胞、自然杀伤细胞和干扰素系统抑制水平下降,这表明违反了适应机制,导致身体抵抗力下降。对细胞因子系统的分析表明,与一组实际健康的人相比,急性呼吸道病毒感染患者的分泌和血清IL-8浓度增加。在ARVI后1个月的免疫状态中,t淋巴细胞数量显著增加,辅助t淋巴细胞倾向于使携带IFN-α和-γ受体的t淋巴细胞正常化,而b淋巴细胞数量保持显著减少。与重组IFN-α-2b联合治疗的免疫调节效果表现为诱导的IFN-α在初始抑制期数量增加,而初始过量产生量减少。IFN-α初始诱导水平低于200 pg/ml时,分泌IL-8和IgA浓度升高。结论。在有条件健康的个体中,在有组织群体形成的前3个月,在34%的病例中发现免疫反应失调。观察重组IFN-α-2b联合治疗对干扰素的调节作用。
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引用次数: 0
Structure and Ways of Strengthening Human Psychological Resources in Stress Situation 应激情境下强化人心理资源的结构与途径
Pub Date : 2022-04-30 DOI: 10.33978/2307-3586-2022-18-14-48-52
L. D. Firsova
The negative impact of chronic stress on the development, treatment and prognosis of gastroenterological diseases is beyond doubt. In recent years, much attention has been paid to the mental state of the doctors themselves, as a result, such a category as professional burnout syndrome is generally recognized. One of the best ways out of stressful situations is to activate the psychological resource of a person. The lecture gives a definition of a psychological resource with a detailed description of its components, special attention is paid to the issues of its strengthening in a situation of chronic stress. The issues discussed are significant for gastroenterologists both in terms of communication with patients and in terms of regulating their own mental state.
慢性应激对胃肠疾病的发展、治疗和预后的负面影响是毋庸置疑的。近年来,由于对医生自身心理状态的关注越来越多,职业倦怠综合征这一类别得到了普遍认可。摆脱压力的最好方法之一就是激活一个人的心理资源。讲座给出了心理资源的定义,并详细描述了其组成部分,特别关注其在慢性压力情况下加强的问题。讨论的问题是重要的胃肠病学家无论是在沟通方面与患者和调节自己的精神状态。
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引用次数: 0
Dumping Syndrome: a Modern View of Pathogenesis, Diagnosis and Treatment 倾倒综合征:病因、诊断与治疗的现代观
Pub Date : 2022-04-30 DOI: 10.33978/2307-3586-2022-18-14-42-47
O.Yu. Gasieva, Y. Embutnieks, O. Berezina, D. Bordin
The literature review summarizes modern ideas about the pathogenesis of dumping syndrome, a pathological condition that occurs after gastric resection. Presented the principles of detecting and correcting of the manifestations of dumping syndrome, which allow improving postoperative rehabilitation and ensuring the acceptable quality of life for patients.
本文对胃切除后发生的倾泻综合征的发病机制进行综述。提出倾倒综合征表现的发现和纠正原则,以提高术后康复,保证患者可接受的生活质量。
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引用次数: 1
Viral Hepatitis Is a Possible Trigger for Autoimmune Liver Diseases 病毒性肝炎可能引发自身免疫性肝病
Pub Date : 2022-04-30 DOI: 10.33978/2307-3586-2022-18-14-28-34
E. Sbikina, S. Batskikh, A. Dorofeev, E. Vinnitskaya, J.B. Borunova, K. Saliev, Y. Sandler, T. Khaimenova, D. Bordin
In recent years, there has been an increase in the incidence of autoimmune liver diseases (AILD) among women and men in all age groups, their etiology remains unknown. The purpose of the study. To confirm the possible role of hepatitis viruses in the development of AILD. Material and methods. During the period 2019–2021, 141 patients with AILD were examined in the department of chronic liver Diseases of Moscow Clinical Scientific and Practical center named after A.S. Loginov of the Moscow Department of Health. The examination included the determination of anti-HAV IgG, anti-HEV IgG, HBsAg, anti-HBcorе IgG, anti-HBs, anti-HCV, DNA HBV, RNA HCV, ANA-НЕр-2, liver fibroelastometry (FE), magnetic resonance cholangiopancreatography (MRCP), liver biopsy (LB). The risk of developing AILD in people who have had hepatitis A, B, and E virus infections was assessed by calculating the odds ratio. Statistical processing was carried out by standard methods. Results. The main group consisted of patients with AILD (n = 139) of them with AIH (n = 46), PBC (n = 74), PSC (n = 19), the control group (KG) (n = 125) – without chronic liver diseases. The high prevalence of IgG class antibodies to hepatitis viruses (HV) A, B, E was reliably demonstrated among patients with AILD (n = 104; 74.8%) compared with KG (n = 68; 54.4%), P < 0.001, and anti-HCV was most often detected (n = 87; 63%), p < 0.002 and anti-HBcore (n = 36;25%), p < 0.031. The highest prevalence of anti-HAV and anti-HBcore was determined – 70% (p < 0.001) and 29% (p < 0.016), respectively, in the PBC group. No significant differences were obtained for PSC and AIH. HBV DNA was detected in the blood of two patients n = 2 (2.5%), that the presence of DNA latent viral hepatitis B. Conclusion. As a result of the study, the epidemiological relationship of transferred viral hepatitis A and B with AILD (in particular, PBС) was revealed. The data obtained confirm the role of hepatitis viruses as possible triggers of AILD and the probable involvement of HBV infection in the pathogenesis of PBC.
近年来,自身免疫性肝病(AILD)的发病率在所有年龄组的男性和女性中都有所增加,其病因尚不清楚。研究的目的。目的:确认肝炎病毒在AILD发展中的可能作用。材料和方法。在2019-2021年期间,以莫斯科卫生部A.S. Loginov命名的莫斯科临床科学与实践中心的慢性肝病科对141名AILD患者进行了检查。检查包括抗hav IgG、抗hev IgG、HBsAg、抗hbcor_ IgG、抗hbs、抗HCV、DNA HBV、RNA HCV、ANA-НЕр-2、肝纤维弹性测定(FE)、磁共振胰胆管造影(MRCP)、肝活检(LB)。通过计算优势比来评估患有甲型、乙型和戊型肝炎病毒感染的人发生AILD的风险。采用标准方法进行统计处理。结果。主要组为AILD患者(n = 139),其中合并AIH (n = 46)、PBC (n = 74)、PSC (n = 19),对照组(KG) (n = 125)无慢性肝病。抗肝炎病毒(HV) A、B、E的IgG类抗体在AILD患者中有较高的流行率(n = 104;74.8%)与KG相比(n = 68;54.4%), P < 0.001,最常检测到抗- hcv (n = 87;63%), p < 0.002; anti-HBcore (n = 36;25%), p < 0.031。抗hav和抗hbcore的最高患病率在PBC组分别为70% (p < 0.001)和29% (p < 0.016)。PSC和AIH无显著性差异。在2例患者的血液中检测到HBV DNA n = 2(2.5%),表明存在乙肝潜伏病毒DNA。研究结果揭示了转移性病毒性甲型肝炎和乙型肝炎与AILD(特别是PBС)的流行病学关系。获得的数据证实肝炎病毒可能是AILD的触发因素,HBV感染可能参与PBC的发病机制。
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引用次数: 0
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Effective Pharmacotherapy
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