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Тезисы Конгресса ревматологов, посвященного 100-летию со дня рождения академика В.А. Насоновой 风湿病学家大会论文:纪念 V.A. 纳索诺娃院士诞辰 100 周年
Pub Date : 2023-12-01 DOI: 10.47360/1995-4484-2023-5s
Article Editorial
.
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引用次数: 0
Modern concept of autoimmunity in rheumatology 风湿病自身免疫的现代概念
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-397-420
E. Nasonov
Two fundamental pathologic processes are central to the spectrum of chronic inflammation mechanisms: autoimmunity and autoinflammation. Autoimmunity and autoinflammation are mutually potent pathologic processes; their development is considered within the framework of the “immunoinflammatory” continuum, reflecting the close relationship between innate and acquired types of immune response. Autoimmunity is the leading mechanism of pathogenesis of a large group of chronic inflammatory human diseases, defined as autoimmune diseases, the frequency of which in the population exceeds 10%. Advances in molecular biology, pharmacogenetics and bioinformatics have created prerequisites for individualization of therapy of autoimmune rheumatic diseases within the concept of personalized medicine. The study of immunopathogenesis mechanisms, improvement of diagnostics, deciphering the nature of molecular taxonomy, development of approaches to prevention and personalized therapy of human autoimmune diseases is among the priority directions of medicine of the 21st century.
两种基本的病理过程是慢性炎症机制的核心:自身免疫和自身炎症。自身免疫和自身炎症是相互作用的病理过程;它们的发展被认为是在“免疫炎症”连续体的框架内,反映了先天和获得性免疫反应类型之间的密切关系。自身免疫是一大群慢性炎症性人类疾病的主要发病机制,被定义为自身免疫性疾病,其在人群中的发病率超过10%。分子生物学、药物遗传学和生物信息学的进步为个体化医疗概念下自身免疫性风湿病的个体化治疗创造了先决条件。研究免疫发病机制,改进诊断方法,破解分子分类的本质,开发人类自身免疫性疾病的预防和个性化治疗方法是21世纪医学的优先方向之一。
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引用次数: 0
Our history. Rheumatology schools 我们的历史。风湿病学学校
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-430-433
V. N. Amirjanova, E. Nasonov
.
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引用次数: 0
The use of methotrexate in rheumatoid arthritis. Recommendations of the All-Russian public organization “Association of Rheumatologists of Russia” 甲氨蝶呤在类风湿性关节炎中的应用。全俄公共组织“俄罗斯风湿病学家协会”的建议
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-435-449
E. Nasonov, V. N. Amirjanova, Y. Olyunin, Y. Muravyev, A. Baranov, E. Zonova, E. Otteva, A. Zagrebneva, D. Abdulganieva, P. I. Pchelnikova
Rheumatoid arthritis (RA) is the most frequent immunoinflammatory (autoimmune) rheumatic disease characterized by chronic erosive arthritis and systemic damage to internal organs. The data obtained in the course of basic research on deciphering the mechanisms of action of methotrexate (MT) and the materials of numerous randomized placebocontrolled trials, observational studies and national registries have strengthened the position of MT as the “gold standard” of RA pharmacotherapy and a key component of the “Treatment to Target” strategy. This was the basis for the development of new recommendations of the Association of Rheumatologists of Russia (ARR) concerning the use of MT in RA, according to which MT is considered as the drug of “choice” for induction and maintenance of remission in patients with early and advanced RA, including those who need combination therapy of MT with glucocorticoids, standard Disease-Modifying Antirheumatic Drugs (DMARDs), biologics and targeted synthetic DMARDs. Special attention is paid to the safety of MT therapy and the impact of MT on comorbid pathology associated with cardiovascular complications and interstitial lung disease. Implementation of the ARR recommendations into clinical practice will reduce the risk of disability and improve life prognosis in patients with RA.
类风湿性关节炎(RA)是最常见的免疫炎症(自身免疫性)风湿性疾病,其特征是慢性糜糜性关节炎和内脏器官的系统性损害。在解密甲氨蝶呤(MT)作用机制的基础研究过程中获得的数据,以及大量随机安慰剂对照试验、观察性研究和国家登记的资料,都加强了MT作为RA药物治疗的“金标准”和“治疗到目标”策略的关键组成部分的地位。这是俄罗斯风湿病学家协会(ARR)关于在RA中使用MT的新建议的基础,根据该建议,MT被认为是早期和晚期RA患者诱导和维持缓解的“首选”药物,包括那些需要MT与糖皮质激素、标准疾病改善抗风湿药物(DMARDs)、生物制剂和靶向合成DMARDs联合治疗的患者。特别关注MT治疗的安全性以及MT对与心血管并发症和间质性肺疾病相关的合并症病理的影响。在临床实践中实施ARR建议将降低RA患者的残疾风险并改善其生活预后。
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引用次数: 0
Evaluation of the possibility of axial psoriatic arthritis patients meet classification criteria for axial spondyloarthritis and ankylosing spondylitis 评价中轴性银屑病关节炎患者是否符合中轴性脊柱炎和强直性脊柱炎的分类标准
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-493-500
E. Gubar, T. Korotaeva, Y. Korsakova, E. Loginova, A. Smirnov, A. Sukhinina, M. Urumova, S. Glukhova
Objective – to analyze whether axial psoriatic arthritis (axPsA) patients meet classification criteria for axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS).Subjects and methods. 104 patients (66 men and 38 women) with PsA according to CASPAR criteria were examined, all patients had back pain. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Back pain not meeting the ASAS criteria was taken to be chronic back (chrBP). Patients underwent hands, feet and pelvis, cervical spine and lumbar spine X-rays. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated. Radiographically significant sacroiliitis (r-sSI) was defined as bilateral grade ≥2 or unilateral grade ≥3. 19 patients without r-sSI underwent sacroiliac joints MRI. 93 patients underwent HLA B27 examination. The number of patients who met the criteria for axSpA (ASAS) and the modified New York (mNY) criteria for AS was determined.Results. IBP was identified in 67 (64.4%), chrBP in 37 (35.6%) patients; 31 (29.8%) patients were of advanced age (over 40) at the onset of IBP/chrBP; 57 (58.8%) cases had r-sSI; 6 (31.6%) patients had MRI-SI; syndesmophytes were detected in 57 (58.8%) cases. Among 40 patients without r-sSI, 19 (47.5%) had syndesmophytes. In 38 (39.2%) out of 97 patients r-sSI was detected along with syndesmophytes, while 19 (19.6%) out of 97 patients had isolated r-sSI without spondylitis, and 19 (19.6%) out of 97 patients had isolated syndesmophytes without r-sSI. HLA B27 was present in 28 (30.1%) cases. 51 (55.4%) patients met criteria for axSpA. 41 (44.6%) patients didn’t meet criteria for axSpA, however 27 (65.9%) of them had syndesmophytes. 48 (48.5%) PsA patients met mNY criteria for AS.Among these patients a set of specific features was revealed: 18 (37.5%) had no IBP, 18 (37.5%) were of advanced age (over 40) at the onset of IBP/ chrBP, 34 (70.8%) had dactylitis, 38 (79.2%) – erosive polyarthritis, 23 (48.8%) – periarticular osteo-proliferative lesions, 14 (30.2%) – osteolysis, 23 (48,9%) – “chunky” non-marginal syndesmophytes, 40 (82,6%) – nail psoriasis, 28 (66,6%) patients were HLA-B27 negative.Conclusion. 45% of axPsA patients don’t meet criteria for axSpA. Characteristic features have been identified to differentiate axPsA from AS.
目的分析中轴性银屑病关节炎(axPsA)患者是否符合中轴性脊柱炎(axSpA)和强直性脊柱炎(AS)的分类标准。研究对象和方法。根据CASPAR标准检查了104例PsA患者(男66例,女38例),所有患者均有腰痛。根据ASAS标准评估患者是否存在炎症性背痛(IBP)。不符合ASAS标准的背痛被认为是慢性背痛(chrBP)。患者接受手、脚、骨盆、颈椎和腰椎x光检查。评估糜烂、骨溶解和关节周围骨增生性病变。影像学上明显的骶髂炎(r-sSI)定义为双侧≥2级或单侧≥3级。无r-sSI的19例患者行骶髂关节MRI检查。93例患者行HLA B27检测。确定了符合AS的axSpA (ASAS)标准和修改后的New York (mNY)标准的患者人数。67例IBP(64.4%), 37例chrBP (35.6%);31例(29.8%)IBP/chrBP发病时为高龄(40岁以上);57例(58.8%)为r-sSI;6例(31.6%)患者有mri;并发真菌57例(58.8%)。在40例无r-sSI的患者中,19例(47.5%)有综合征。97例患者中有38例(39.2%)伴有r-sSI,而97例患者中有19例(19.6%)无脊柱炎分离出r-sSI, 97例患者中有19例(19.6%)无r-sSI分离出综合征。HLA B27阳性28例(30.1%)。51例(55.4%)患者符合axSpA标准。41例(44.6%)患者不符合axSpA标准,但27例(65.9%)患者存在综合征。48例(48.5%)PsA患者符合mNY AS标准。其中18例(37.5%)无IBP, 18例(37.5%)在IBP/ chrBP发病时年龄较大(40岁以上),34例(70.8%)患有指突炎,38例(79.2%)患有糜烂性多关节炎,23例(48.8%)患有关节周骨增生性病变,14例(30.2%)患有骨溶解,23例(48.9%)患有“块状”非边缘综合征,40例(82.6%)患有指甲银屑病,28例(66.6%)患者HLA-B27阴性。45%的axPsA患者不符合axSpA的标准。已经确定了区分axPsA和AS的特征。
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引用次数: 0
Rituximab in the treatment of systemic sclerosis. Literature review 利妥昔单抗治疗系统性硬化症。文献综述
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-466-474
L. Garzanova
Systemic sclerosis (SSc) is one of the most severe systemic rheumatic diseases, characterized by the development of progressive skin fibrosis and damage to internal organs, accompanied by a decrease in the quality of life and high mortality. The treatment of SSc remains a difficult clinical task due to the complex pathogenesis. Nowadays therapy is complex and based on the dominant clinical and pathogenetic phenotype of SSc. However, standard therapy have limited potential to radically improve the prognosis of SSc, and often their use can lead to the development of intolerance and adverse events. In this connection, it remains relevant to study and introduce new approaches for the treatment of SSc, one of which is anti-B-cell therapy. Based on the data on the key role of B cells in the regulation of inflammatory and fibrotic processes in SSc, rituximab (chimeric monoclonal antibody to B-lymphocyte surface receptors – CD20) is increasingly being studied and used in clinical practice for the treatment of this disease. This review collects and analyzes data on the efficacy, safety and impact of rituximab on various manifestations of SSc.
系统性硬化症(SSc)是最严重的系统性风湿病之一,其特征是进行性皮肤纤维化和内脏器官损伤,伴随着生活质量下降和高死亡率。由于其复杂的发病机制,SSc的治疗仍然是一项困难的临床任务。目前的治疗是复杂的,并以SSc的主要临床和病理表型为基础。然而,标准治疗从根本上改善SSc预后的潜力有限,而且通常使用标准治疗会导致不耐受和不良事件的发生。因此,研究和引入治疗SSc的新方法仍然具有重要意义,其中之一是抗b细胞治疗。基于B细胞在SSc中调节炎症和纤维化过程中的关键作用的数据,利妥昔单抗(B淋巴细胞表面受体- CD20的嵌合单克隆抗体)越来越多地被研究并用于临床治疗该疾病。本综述收集和分析了利妥昔单抗对SSc各种表现的疗效、安全性和影响的数据。
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引用次数: 0
Dynamics of clinical manifestations and cytokine concentrations in patients with rheumatoid arthritis on olokizumab therapy 类风湿关节炎患者在olokizumab治疗下的临床表现和细胞因子浓度的动态变化
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-475-484
N. Lapkina, A. A. Baranov, N. Levshin, A. Kolinko, L. Mineeva, A. Artyuhov, E. Nasonov
The aim of the study was to investigate the dynamics of clinical and laboratory parameters of inflammatory disease activity and cytokines in patients with rheumatoid arthritis (RA) against the background of olokizumab (OKZ) treatment.Materials and methods. Ten patients with a reliable diagnosis of RA were examined: patients’ age was 46.00 (30.00; 60.00) years, duration of disease was 9.0 (3.0; 12,0) years. All patients had moderate to high disease activity: DAS28-ESR (Disease Activity Score 28 with Erythrocyte Sedimentation Rate) – 513 (4.34; 5,80); CDAI (Clinical Disease Activity Index) – 30.00 (24.00; 35.00); SDAI (Simplified Disease Activity Index) – 31.86 (24.36; 38.59). All patients were treated with OKZ at a dose of 64 mg subcutaneously every 4 weeks on the background of therapy with methotrexate, leflunomide, nonsteroidal anti-inflammatory drugs, and glucocorticoids. Observations were performed before treatment and after 3, 6 months of therapy. Serum levels of 15 cytokines: interleukin (IL) 1β, IL-4, IL-6, tumor necrosis factor α (TNF-α), interferon (INF) γ, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, sCD40L, – were examined using multiplex xMAR technology.Results. After 3 and 6 months of OKZ therapy, there was a significant decrease in DAS28-ESR of 3.53 (2.83; 4.26) and 3.48 (2.8; 4.10); CDAI – 11.00 (6.0; 16.00) and 10.0 (5.0; 15.0); SDAI – 10.0 (5.0; 15.0) and 10.17 (7.02; 15.02); C-reactive protein (CRP) concentrations (initial – 14.30 (7.00; 24.70) mg/l, after 3 months – 0.70 (0.40; 0.90) mg/l and after 6 months – 0.65 (0.20; 3.00) mg/l). After 3 months of treatment we found an increase in IL-6 concentration (initial – 1.89 (1.61; 2.33) pg/ml and 89.98 (35.09; 165.84) pg/ml; p<0.01), after 6 months – its level decreased to 44.88 (5.25; 80.90) pg/ml without reaching, however, the initial values (p<0.05). Against the background of OCZ, after 3 months of treatment there was an increase in IL-25 concentration (p<0.01), and after 6 months of therapy – TNF-α (p<0.05).Conclusion. The use of OKZ leads to an increase in the concentration of total IL-6 in the blood serum of RA patients, while the clinical and laboratory activity of the disease decreases.
该研究的目的是在olokizumab (OKZ)治疗的背景下,研究类风湿关节炎(RA)患者炎症疾病活动性和细胞因子的临床和实验室参数的动态。材料和方法。对10例可靠诊断为RA的患者进行了检查:患者年龄为46.00岁(30.00岁;60.00)年,病程9.0 (3.0;12,0)年。所有患者均有中度至高度疾病活动性:DAS28-ESR(疾病活动性评分28伴红细胞沉降率)- 513 (4.34;5, 80);CDAI(临床疾病活动指数)30.00 (24.00;35.00);SDAI(简化疾病活动指数)- 31.86 (24.36;38.59)。所有患者在接受甲氨蝶呤、来氟米特、非甾体抗炎药和糖皮质激素治疗的基础上,每4周皮下注射64mg OKZ。分别于治疗前、治疗后3、6个月进行观察。采用多重xMAR技术检测血清15种细胞因子:白细胞介素(IL) 1β、IL-4、IL-6、肿瘤坏死因子α (TNF-α)、干扰素(INF) γ、IL-10、IL- 17a、IL- 17f、IL-21、IL-22、IL-23、IL-25、IL-31、IL-33、sCD40L、-的水平。OKZ治疗3个月和6个月后,DAS28-ESR显著下降,分别为3.53 (2.83;4.26)和3.48 (2.8;4.10);Cdai - 11.00 (6.0;16.00)和10.0 (5.0;15.0);Sdai - 10.0 (5.0;15.0)和10.17 (7.02;15.02);c反应蛋白(CRP)浓度(初始值- 14.30 (7.00;24.70) mg/l, 3个月后- 0.70 (0.40;0.90) mg/l, 6个月后- 0.65 (0.20;3.00 mg / l)。治疗3个月后,我们发现IL-6浓度升高(初始- 1.89 (1.61;2.33) pg/ml和89.98 (35.09;165.84) pg / ml;P <0.01), 6个月后降至44.88 (5.25;80.90) pg/ml,但未达到初始值(p<0.05)。在OCZ背景下,治疗3个月后IL-25浓度升高(p<0.01),治疗6个月后TNF-α浓度升高(p<0.05)。OKZ的使用导致RA患者血清中总IL-6浓度升高,而疾病的临床和实验室活动降低。
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引用次数: 0
Monogenic autoinflammatory syndromes with features of systemic vasculitis: a new field of rheumatology 具有系统性血管炎特征的单基因自身炎症综合征:风湿病学的一个新领域
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-458-465
T. Beketova, M. Beketova, E. Nasonov
The article is dedicated to a new actual problem in rheumatology: vasculitis and vasculitis-like manifestations in monogenic autoinflammatory syndromes in adult. The features of the clinical course of the rarely diagnosed VEXAS syndrome, as well as the SAVI and COPA syndromes, which sometimes occur in adults, are considered. Promising directions of future treatment are discussed.
本文致力于风湿病学中的一个新的实际问题:成人单基因自身炎症综合征中的血管炎和血管炎样表现。考虑到罕见诊断的VEXAS综合征的临床病程特点,以及有时发生在成人中的SAVI和COPA综合征。讨论了今后的治疗方向。
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引用次数: 0
Rheumatoid arthritis and COVID-19: Three years later 类风湿性关节炎和COVID-19:三年后
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-450-457
B. Belov, E. Aronova, G. Gridneva, E. Nasonov
During the three years that have passed since the beginning of the COVID-19 pandemic, many new fundamental and medical problems have been discovered regarding the relationship between the viral infection and many common chronic non- infectious diseases. Among the latter, an important position is occupied by immuno-inflammatory rheumatic diseases (IIRD), which include rheumatoid arthritis (RA). To date, there is no doubt that patients with RA are at risk for SARS-CoV-2 infection, a severe course of infection that necessitates hospitalization and death. The article presents current data on the course and outcomes of COVID-19 in patients with RA. The literature and own data on postcovid syndrome in this group of patients are presented. The necessity of vaccination against SARS-CoV-2 in patients with IIRD, including those with RA, was substantiated. The prospects for further study of the features of COVID-19 in patients with RA are outlined.
新冠肺炎大流行发生3年来,在病毒感染与许多常见慢性非传染性疾病的关系方面,人们发现了许多新的基础问题和医学问题。其中,类风湿关节炎(RA)等免疫炎性风湿疾病(IIRD)占据重要地位。迄今为止,毫无疑问,类风湿性关节炎患者有感染SARS-CoV-2的风险,这是一个需要住院和死亡的严重感染过程。这篇文章介绍了目前关于COVID-19在RA患者中的病程和结果的数据。本文介绍了这组患者的covid后综合征的文献和自己的数据。对IIRD患者(包括RA患者)接种SARS-CoV-2疫苗的必要性已得到证实。本文对RA患者COVID-19特征的进一步研究进行了展望。
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引用次数: 0
The use of “Acellbia” – a biosimilar of rituximab in systemic sclerosis 利妥昔单抗在系统性硬化症中的生物仿制药“Acellbia”的使用
Pub Date : 2023-08-31 DOI: 10.47360/1995-4484-2023-485-492
L. Ananyeva, L. Garzanova, O. Desinova, R. Shayakhmetova, M. Starovoytova, O. Koneva, O. Ovsyannikova, S. Glukhova, E. Nasonov
Introduction. The possibilities of modern therapy for systemic sclerosis (SSc) remains limited, since most of the used drugs do not have a diseasemodifying effect. This encourages the study of new approaches that potentially affect the fundamental pathological processes underlying the disease. One example is anti-B cell therapy, in particular rituximab (RTX). Until now RTX do not have a registration for the treatment of SSc, but there is a large positive experience of its use, which is reflected in recent meta-analyses and clinical recommendations. Complicated and expensive methods for obtaining genetically engineered biological preparations have contributed to the emergence of more accessible biosimilars, one of which is the RTX biosimilar, Acellbia (Biocad, Russian Federation). The “biosimilar” versions of RTX might reduce the cost of therapy and increase patients accessibility to this treatment option. The RTX biosimilar Acellbia (ACB) has received approval in Russian Federation in 2014 for all indications held by reference RTX (including rheumatoid arthritis and ANCA-associated vasculitis).The aim of this study was to investigate the efficacy and safety of Acellbia in patients with systemic sclerosis.Material and methods. Our prospective uncontrolled study included 20 patients (14 women) aged 50±14 years, with a disease duration of 3.5±2.7 years. Indications for the prescribing of ACB were high disease activity and the presence of risk factors for progression. All patients had radiological signs of interstitial lung disease, 13 (65%) were positive for antibodies to topoisomerase 1. None of the patients had previously been treated with biological therapy. All patients received glucocorticoids in low doses and 15 (75%) patients were not on concomitant immunosuppressants during the study. ACB was administered in doses of 2 g (two doses of 1 g with a weekly interval) at inclusion of the study and after 6–8 months according to the same scheme, cumulative dose – 4 g. An assessment of basic measurements was obtained at baseline (Point 0), before the second course (after 7.2±1.7 mo, Point 1) and at the end of follow-up (13.4±1.6 mo, Point 2). The results are presented in the form of mean values and standard deviations.Results. There was a positive effect on the main manifestations of the disease, which accompanied by stable depletion of CD19+ B lymphocytes in the peripheral blood. At the intermediate assessment (between points 0–1), no significant changes were observed, with the exception of the skin score. At the end of the study, most of the parameters showed a significant improvement between points 0–2. The activity of the disease (EScSG-AI) decreased, and the skin score decreased from 12.8±11 to 6.2±5.6 (p=0.002). The forced vital capacity (% of predicted) increased from 89±18.2 to 98.26±16.13% (p=0.0002), and the diffusion capacity of the lungs (% of predicted) increased from 56.8±15.7 to 61.9±17.2% (p<0.019). A significant decrease in CRP, anti
介绍。现代治疗系统性硬化症(SSc)的可能性仍然有限,因为大多数使用的药物没有改善疾病的作用。这鼓励了对潜在影响疾病基本病理过程的新方法的研究。一个例子是抗b细胞治疗,特别是利妥昔单抗(RTX)。到目前为止,RTX还没有注册用于治疗SSc,但在最近的荟萃分析和临床建议中反映了其使用的大量积极经验。获得基因工程生物制剂的复杂和昂贵的方法促成了更容易获得的生物类似药的出现,其中之一是RTX生物类似药Acellbia (Biocad,俄罗斯联邦)。RTX的“生物仿制药”版本可能会降低治疗成本,并增加患者对这种治疗选择的可及性。RTX生物仿制药Acellbia (ACB)已于2014年在俄罗斯联邦获得批准,用于参考RTX持有的所有适应症(包括类风湿性关节炎和anca相关血管炎)。本研究的目的是探讨Acellbia对系统性硬化症患者的疗效和安全性。材料和方法。本前瞻性非对照研究纳入20例患者(14例女性),年龄50±14岁,病程3.5±2.7年。ACB的适应症是疾病活动性高和存在进展危险因素。所有患者均有肺间质性疾病的影像学征象,13例(65%)拓扑异构酶1抗体阳性。这些患者之前都没有接受过生物疗法。所有患者均接受低剂量糖皮质激素治疗,15例(75%)患者在研究期间未同时使用免疫抑制剂。ACB在纳入研究时和6-8个月后按照相同的方案以2g剂量(两次剂量为1g,每周间隔一次)给予,累积剂量- 4g。在基线(0点)、第二疗程前(7.2±1.7个月,1点)和随访结束时(13.4±1.6个月,2点)对基本测量进行评估。结果以平均值和标准差的形式呈现。对本病主要表现有积极作用,伴外周血CD19+ B淋巴细胞稳定耗竭。在中间评估(0-1分之间),除皮肤评分外,未观察到显著变化。在研究结束时,大多数参数在0-2分之间显示出显著的改善。疾病活动性(EScSG-AI)下降,皮肤评分从12.8±11降至6.2±5.6 (p=0.002)。用力肺活量(预测的%)由89±18.2%提高到98.26±16.13% (p=0.0002),肺弥散量(预测的%)由56.8±15.7%提高到61.9±17.2% (p<0.019)。CRP、抗拓扑异构酶-1抗体和IgG显著下降(从12.6±2.6 g/l降至10.2±2.2 g/l)。在任何情况下,B淋巴细胞都没有恢复到正常水平,在研究结束时,83%的患者(18人中有15人)保持了B淋巴细胞的完全耗尽。生活质量问卷SHAQ改善(p=0.0001),泼尼松龙平均剂量由11.0±2.7 mg/d降至9.4±2.3 mg/d (p=0.03)。9例(45%)患者由于磨玻璃混浊减少,HRCT显示明显阳性变化。不良事件(ae)的频率和频谱与已知的RTX相关。在接受2个疗程ACB治疗的20例患者中,2例因妊娠(1例)和肺癌(1例)在第2点退出评估。9例(45%)患者共报告11例(55%)ae,其中大多数为轻度ae。感染并发症7例(35%),上呼吸道感染4例,TB皮肤试验阳性2例,中耳炎1例,膀胱炎1例,胆囊炎1例,小腿静脉血栓形成1例,肺癌1例。我们的数据表明,Acellbia可以用于治疗SSc。一项短期、前瞻性、非对照研究表明,ACB生物类似药在SSc中具有良好的疗效和可接受的安全性。皮肤纤维化的显著减少和肺功能的改善已被证实。ACB的临床疗效在开始治疗后6个月表现出来,在开始治疗后1年达到顶峰。由于ACB的阳性疗效,可用于对免疫抑制剂无效和/或不耐受的SSc患者,可考虑作为一线治疗。我们的数据应该得到对照临床试验结果的证实。
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引用次数: 0
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Rheumatology Science and Practice
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