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

E. Nasonov, V. N. Amirjanova, Y. Olyunin, Y. Muravyev, A. Baranov, E. Zonova, E. Otteva, A. Zagrebneva, D. Abdulganieva, P. I. Pchelnikova
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引用次数: 0

摘要

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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The use of methotrexate in rheumatoid arthritis. Recommendations of the All-Russian public organization “Association of Rheumatologists of Russia”
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.
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