Rheumatoid arthritis: treatment, new drugs

Preparations of a new generation for the treatment of rheumatoid arthritis

Treatment of rheumatoid arthritis with new generation drugs helps to improve the condition of sick people and prevent their early disability.

In the absence of timely therapy, disability can occur only 5 years after the appearance of the first signs of pathology. Chronic disease causes destruction of articular cartilage and bone.

It is accompanied by autoimmune disorders and leads to the development of systemic inflammatory processes. Rheumatoid arthritis not only significantly impairs people's quality of life, but also shortens their life.

Basic therapy of rheumatoid arthritis

Treatment of rheumatoid arthritis is carried out with the help of basic anti-inflammatory drugs (CPAP).

They are the main element of drug therapy of the disease and are assigned to each patient in the absence of contraindications to it.

BMD help to quickly stop the symptoms of active rheumatoid arthritis, in addition, to stop the destructive processes in articular and periarticular tissues.

They are recommended even before the diagnosis is clarified. Basic therapy will help prevent serious deformations of joints, cardiovascular pathologies and osteoporotic fractures.

Basic medicines refer to immunosuppressors. Medicamentous immunosuppression (suppression of immunity) is the basis of treatment of rheumatoid arthritis.

To achieve a significant improvement in the condition of the patient with arthritis and slow progression pathological processes, immunosuppressive therapy should be differentiated, prolonged and continuous.

Basic drug Methotrexate

The gold standard for the treatment of rheumatoid arthritis is Methotrexate.

Drug medication aimed at inhibition and inhibition of pathological fission processes and growth of connective tissue (cytostatic), belongs to the group of antimetabolites, antagonists of folic acid acid.

It inhibits cell division, inhibits the synthesis and function of DNA repair, and, to a lesser extent, affects the production of RNA and protein.

Methotrexate has a pronounced immunosuppressive effect even at relatively low dosages. Approximately 70% of patients with rheumatoid arthritis who use Methotrexate eventually develop persistent remission of the disease.

The drug is well tolerated by patients. They rarely complain about negative manifestations. A fifth of patients are faced with skin eruptions, stool disorder, difficulty in urinating and "running creepy."

When appointing Methotrexate, clinical and laboratory monitoring is performed, which allows to identify failures in the work of the kidneys, liver and hemopoiesis system at an early stage.

If a negative change is detected, the dosage is adjusted.

Methotrexate is taken orally weekly at one time or in 3-4 divided doses at intervals of 12 hours.

If a patient has a complaint about digestive problems, the basal drug can be administered intravenously or intramuscularly.

Every 2-4 weeks, the dosage is increased, achieving the desired clinical result. Already after 1, a month the patient feels a significant improvement in his state of health.

The preparation of basic therapy Leflunomide (Arava)

The drug Arava is designed specifically for the treatment of rheumatoid arthritis. It inhibits the production of the dehydroorotate dehydrogenase enzyme, which takes part in the synthesis of uridine monophosphate. The inhibition of the production of pyrimidine nucleotides leads to a change in the autoimmune response.

Restraining the development of rheumatoid arthritis, Leflunomide has no effect on human phagocytosis. It is effective at an early and late stage of the disease. Anti-inflammatory effect develops after 30 days of its application.

On average, relief of the patient's health appears at week 9 of therapy.

After 6 months of therapy, there is a decrease in the rate of progression of rheumatoid arthritis. The number of new erosions in the joints of the feet and hands is significantly reduced.

The conducted studies confirmed the high effectiveness of the drug in 3 years after the start of its use.

A favorable result from leflunomide therapy is noted in 94% of cases. Arava demonstrates a higher effectiveness, in comparison with the "gold standard" of therapy - Methotrexate. A similar result develops only after 1 year of use of Methotrexate.

The drug Arava is prescribed according to the standard scheme. For the first 3 days the maximum dose is applied, then the amount of the drug is reduced. If there is a possibility of intolerance to the drug, the initial dose is reduced. Leflunomide perceives patients better than Methotrexate.

Treatment of rheumatoid arthritis with gold

Basic therapy of pathology can be carried out with gold salts. Aurotherapy gives good results at the initial stage of the development of the disease. It is indicated to people whose pathology develops rapidly.

Gold preparations are prescribed for people suffering from painful joint pains and hours of morning stiffness.

They will help in cases where other painkillers do not have the desired effect.

Recommended aurotherapy for seropositive rheumatoid arthritis. In such patients, destructive processes in the cartilaginous tissue are significantly slowed down.

The formation of bone cysts and erosions is suspended. Gold salts improve the mineralization of bones.

There are cases of disappearance of bone erosions inside the bones of the affected joints of the feet and brushes.

Aurotherapy helps to cure juvenile rheumatoid arthritis. It helps to relieve the condition of people who have been diagnosed with serious complications of rheumatoid arthritis - Felty's syndrome or Sjogren's syndrome. In the latter case, gold salts will help to cope only with the symptoms of the disease.

Gold salts can be used for concomitant diseases, including infectious and oncological diseases. They additionally have antibacterial and antifungal effect.

The expected result is noticeable in 2-3 months.

If half a year after the start of gold salts reception there are no positive changes, treatment should be stopped in view of its inexpediency.

Adverse reactions of aurotherapy

The marked improvement in the condition of the joints is often accompanied by the manifestation of adverse reactions. Patients show a rash in the form of pink spots and small vesicles intensively itching. Symptoms of skin reactions appear stronger under the sun.

The skin can acquire a bronze tone. Sometimes salts of gold are deposited, forming on the skin spots of purple. Dermatological reactions that occur with aurotherapy are often mistaken for eczema.

With prolonged use of gold salts, necrosis of skin areas may occur.

With rheumatoid arthritis, gold preparations can provoke nephropathy. In order to prevent complications during aurotherapy, the urine indicators of the patient are monitored. Against the background of treatment with salts of gold, mucous membranes can become inflamed.

Glucocorticosteroids, NSAIDs and sulfonamides

As immunosuppressors in the treatment of rheumatoid arthritis, glucocorticosteroids are used.

They also have an anti-inflammatory effect that can develop within 2-3 hours after intraarticular administration.

With long-term treatment with low doses of glucocorticosteroids, the erosive process in the bones is suppressed, the mobility of the joints is improving.

Rheumatic ailment is treated:

• Prednisolone;
• Triamcinolol;
• Dexamethasone;
• Methylprednisolone;
• Betamethasone.

Hormonal drugs are used systemically (inside) or locally (intraarticular injections). Because of the negative effect on the body, they are used for short periods in severe conditions of patients.

As an emergency aid for a severe pain syndrome, use a non-steroidal anti-inflammatory drug. A new generation of NSAIDs causes far fewer side effects.

Their action is due to the selective blocking of only one isoform of the enzyme cyclooxygenase (COX-2), which controls the production of mediators of pain - prostaglandins.

Selective NSAIDs are easily tolerated by patients and rarely cause diseases of the gastrointestinal tract.

The list of NSAIDs of the new generation contains 2 types of medicines - mainly selective and highly selective.

In the treatment of rheumatoid arthritis, the first species is often preferred (Nimesulid, Movalis). With severe pain, COX-1 concentration increases 4-fold.

Therefore, to achieve an analgesic effect, it is better to use NSAIDs that block both isoforms of COX-1 and COX-2.

It is not inferior in effectiveness to other DMARD when it is prescribed for the treatment of rheumatoid arthritis with a low rate of progression. Sulfanilamides are well tolerated and do not cause serious complications.

Therapy starts with a minimal dose, gradually increasing it within a month. The expected result is manifested in 6-10 weeks.

Therapy of pathology by biological preparations

Recently, more and more often used biological drugs for the treatment of rheumatoid arthritis.

They are prescribed to patients who have a severe course of rheumatoid arthritis with unfavorable prognosis and steady progression (more than five deformed and inflamed joints).

Biological preparations differ from basic drugs with a quick action.

With their help, you can achieve significant relief of the patient's condition 7-14 days after the first dose. Sometimes the intensity of symptoms decreases sharply after a few days.

By the degree of impact on the body, biological agents can be compared with intensive care medications.

Biological medicines are often used together with basic medicines. They enhance the beneficial effects of each other. This feature is most strongly manifested in combination with Methotrexate.

The term "biological preparations" is referred to medicinal products manufactured with the help of genetic engineering.

They are characterized by a more precise selective effect on the key moments of the inflammation reaction compared to the baseline drugs.

The creation of genetically engineered biological products (GIBP) is one of the most significant achievements of modern pharmacotherapy.

The use of GIBP can significantly reduce the activity of the immune-pathological process and quickly achieve the desired clinical result. With their help, it is possible to improve the quality of life of patients.

GIBP can slow the progression of joint damage even in patients who have not been helped by basic therapy.

The disadvantage of biological drugs is the ability to inhibit anti-infectious and antitumor immunity. Since the biological drug is a protein, there is a high probability of allergic reactions.

Biological preparation Infliximab (Remicade)

The most popular GIBP for rheumatoid arthritis is Infliximab (Remicade). It binds to TNF-alpha, forming a stable compound.

The TNF-a protein is involved in many anti-inflammatory reactions.

After the application of infliximab, the reduction of the joint gap is slower, the erosive process dies out.

Before treatment with infliximab, a patient should be examined for tuberculosis. The initial dose of the drug is administered intravenously drip.

After the abolition of the biological agent, they continue to treat the disease with the basic drugs.

During treatment with biological preparations and for half a year after their abolition, women need to use reliable contraceptives. Infliximab has a pathological effect on the immune system of the developing fetus.

A source: https://OrtoCure.ru/kosti-i-sustavy/artrit/lechenie-revmatoidnogo-artrita-preparatami-novogo-pokoleniya.html

New drugs against rheumatoid arthritis

One of the most common and often occurring ailments for today is rheumatoid arthritis.

This is a systemic disease of connective tissue, which is characterized by chronic inflammation arising in the joint.

The most frequent places of localization of the disease are such joints as: ankle, knee, ankle joints and hands.

As a result of untimely rendering of appropriate treatment, a person begins to feel enormous discomfort, accompanied by loss of mobility in the joint and the subsequent onset of disability.

Effect

To date, a huge amount of medicines has been developed for the treatment of rheumatoid arthritis, but the most effective and most frequently used are new generation drugs that are directed on:

• getting rid of the pain syndrome and inflammatory process;
• prevention of bone destruction with the replacement of any pathological tissue;
• resumption of agility in the joint;
• achievement of an inactive form of the joint disease;
• normalization of human motor activity.

All preparations of the new generation are divided into several groups, namely:

• basic medicinal medicines;
• biological preparations.

Basic

At the initial stage of the course of the joint disease, the use of basic medicines is prescribed, which contribute to the elimination of the inflammatory process. These medications are prescribed for all categories of patients in the absence of any contraindications to their use.

With the help of these drugs, it is possible to quickly localize the symptomatology arising in the case of the transition of the joint an ailment into an active stage of progression, and also to brake the destruction in the joints and tissues surrounding him.

The main medicines related to this group are:

• Methotrexate;
• Leflunomide (Arava).

Methotrexate

This medication is the most commonly used for getting rid of various joint diseases. The substances included in its composition, contribute to a significant slowing down and suppression of the processes of pathological division and growth of connective tissue (cytostatic).

The drug belongs to the group of antimetabolites and is an antagonist of folic acid.

As a result of slowing and delaying cell division, the synthesis and functionality of DNA renewal is suppressed.

In addition, the drug Methotrexate has a small effect on the performance of RNA and protein in the human body.

Also, the drug has a pronounced immunosuppressive effect, even with a small amount of it.

In this regard, the majority of patients who used the medicine to treat this disease, there comes a period of persistent remission, that is, the complete disappearance of symptoms.

A month or a half later, the patient experiences significant improvements. The duration of therapy and the number of receptions depends on the severity of the course of the disease and the severity of the symptoms provoked by it.

Leflunomide (Arava)

This drug was developed to treat connective tissue diseases of the surrounding joint. With his participation, the productivity of dehydrogenate dehydrogenase, a substance that directly participates in the synthesis of uridimonophosphate, is suppressed.

As a result, inhibition of the production of pyrimidine nucleotides and a change in the autoimmune response occur.

The medicine does not allow the disease to progress, thus it does not affect the phagocytosis of a person.

Leflunomide is recommended for use in all stages of the course of rheumatoid arthritis.

After a two-month course of therapy, the patient feels considerable relief. Six months later, the joint ailment ceases to progress, the swelling in the joints disappears, the pain syndrome is eliminated.

The drug Arava is more effective than Methotrexate, because the same result can be achieved only after a year of its use.

There is a specially developed scheme, according to which the use of Arava is prescribed. In the first three days, the drug is taken in the largest amount, after which the dosage is reduced.

Biological

Well-known and often used for the treatment of rheumatoid arthritis are biological medicines. They consist of agents that are specially produced proteins with the active participation of genetic engineering.

The substances differ by an exact selective effect on the key moments of the reaction of the inflammatory process in comparison with the basic means. After their application, the activity of the immunopathological process is significantly reduced, and the progression of joint damage is slowed down.

These drugs are used in cases of very severe course of the disease, rapid progression and pronounced symptomatology caused by it. This group of drugs is different from the basic means of maximum exposure speed.

With the use of biological agents, reducing symptoms and alleviating general condition can be achieved over a period of weeks to two after the start of the procedure.

The most well-known biological preparations for the treatment of rheumatoid arthritis are the following medicines:

• Infliximab;
• Endbrel;
• Kinneret;
• Humirah;
• Remicade.

Infliximab

Infliximab is the newest and most popular remedy, which is designed to get rid of the symptoms of the disease as a whole.

Getting into the bloodstream, the substances that make up the drug, as quickly as possible, bind to extracellular proteins TNF-alpha (taking direct part in anti-inflammatory reactions) and together with them form a stable compound.

After using the medication, the joint space is reduced much more slowly and as a result, the erosive process disappears. The drug is available as a solution, which is intended for intravenous administration.

The duration of therapy is about 12 months. Dosage and the number of injections is administered individually for each patient. At the end of the use of medication infliximab prescribe the use of basic drugs to achieve a more stable therapeutic effect.

Endbrel (etanercept)

This medication has an excellent anti-inflammatory effect and is an inhibitor of tumor necrosis factor alpha (TNF-α). TNF actively participates in the onset of the inflammatory process in rheumatoid arthritis.

The product is available as a lyophilizate, intended for the preparation of a solution, which is injected under the skin at the site of injury.

The absorption process after manipulation is very slow, and the maximum amount in the blood plasma comes after 2 days.

The duration of excretion is 80 hours.

It is forbidden to use the medication during the period of carrying out the baby and breastfeeding it, that there is no evidence of any impact of it on both the future mother and the full development of her the fetus.

Kinneret

Kineret - a new generation of drugs, which is a recombinant interleukin-1 receptor antagonist.

With the help of this influence, the cartilage and bone are protected from destructive processes in them.

In addition, there is a reduction of unpleasant symptoms during the active progression of the disease.

The drug is not prescribed for patients who have violations of the normal functioning of the kidneys and liver and diseases of these organs (renal and hepatic insufficiency). The drug is administered subcutaneously. The duration of treatment with the use of Kineret medicament is prescribed depending on the stage of the disease.

Humirae

Humira is a selective immunosuppressive agent.

The components that are constituents of the drug have an excellent property of binding to the tumor necrosis factor alpha.

As a result, its biological functions are neutralized due to blockade of interaction with surface cellular receptors.

In patients suffering from this disease, Humira's preparation contributes to a rapid decrease in the concentration of acute phase parameters of inflammation. The drug is used for subcutaneous injection. After administration, the medicine is very slowly absorbed.

The maximum amount in the blood plasma comes five days after the manipulation. Drug Humir is administered twice for 30 days. The positive property of this medication is that it does not contribute to the occurrence of various allergic reactions.

Remicade

The main active substance of the drug is infliximab, which helps to reduce the symptoms that have arisen as a result of the inflammation in the connective tissue of the joint. In addition, it significantly improves its functionality and mobility.

Remikade medicament is available as a solution for intravenous infusion. Very often the drug is used in combination with Methotrexate. With the help of such a complex, it is possible to stop the progression of rheumatoid arthritis and achieve a stable stage of remission.

Dosage is selected personally for each patient and is calculated by the formula of 3 mg per kg of weight. Therapeutic effect is observed after 12 weeks of therapy.

Before using any new generation drug, it is necessary to undergo a check-up and consult a specialist about the correct dosage and number of applications.

In order to get rid of rheumatoid arthritis in combination with medications, various Physiotherapeutic procedures, health-improving physical culture, as well as eating rich foods for vitamins and minerals.

A source: https://nogi.guru/zabolevaniya/artrit/revmatoidnyjj/preparaty-novogo-pokoleniya.html

Four effective ways to treat rheumatoid arthritis

Despite the fact that scientists are continuously studying the mechanisms of the development of rheumatoid arthritis - radical therapy, permanently relieving the disease, was never found. The treatment of rheumatoid arthritis today is aimed at reducing symptoms, increasing motor function and prolonging the periods of remission.

The most effective complex treatment, which includes four elements:

1. Medicamentous therapy. This is a basic therapy, the use of non-steroidal anti-inflammatory drugs, glucocorticoids, immunosuppressants, preparations of vitamin D and sulfonamides. An effective treatment regimen, which includes products containing vitamin D. Compensation for the deficiency of this vitamin can slow down the pathological destruction of joint tissues and enhance the effectiveness of the action of medications.

• Therapeutic physical training. Individually selected exercises help to restore joint flexibility to the joints, and the muscles to return to tonus.
• Physiotherapeutic procedures: phonophoresis, UHF, ozocerite and others. The simultaneous application of several types of physiotherapy procedures, for example, phonophoresis and balneotherapy, stimulate work of the immune system, reducing the production of an aggressive agent, and contribute to rapid relief of acute inflammation.
• Folk remedies. Most rheumatologists recognize the positive effect of natural recipes in the treatment regimen of rheumatoid arthritis. They increase the effectiveness of drug treatment, and in 50% of cases it is successfully replaced.

The consoling news for millions suffering from rheumatoid arthritis is the appearance of a large number improved medications that can easily get rid of unpleasant symptoms and reliably control course of the disease.

A completely new class of anti-rheumatic drugs - biological agents (humira, orentsia, emblem and etc.), which in the treatment of rheumatoid arthritis provide long-term remission and prevent the destruction of the joint tissue.

Their action is aimed at correcting the work of the immune system, which gives hope for the ability to effectively treat pathological processes.

The greatest danger of rheumatoid arthritis is the absence of symptoms at the onset of the disease.

A slight discomfort, felt in the morning, which is associated with stiffness of movements and weakness - usually does not cause concern.

As a result, rheumatologists often come for help when the disease has gone far enough and is difficult to treat.

General scheme of therapy for rheumatoid arthritis. Click on photo to enlarge

Four tasks of treating rheumatoid arthritis

Treatment of rheumatoid arthritis can last for many years.It is important not to take breaks at all and not to miss taking medications and performing the prescribed procedures.

The tasks of complex treatment of rheumatoid arthritis:

1. getting rid of weakness, pain, swelling and limited mobility of the joints;
2. prevention of deformation and destruction of joints;
3. an increase in the duration and quality of life of the patient;
4. prolongation of the terms of remission and achievement of its stability.

The method of basic therapy is the basis for treating rheumatoid arthritis with other drugs.

The action of medications included in this group is aimed at suppressing the source of pathology, inadequate response of the immune system.

In most cases, the following drugs are prescribed for basic treatment.

Immunosuppressants (cytotoxic drugs)

Examples of drugs: methotrexate, cyclophosphamide, azathioprine, remicade, leflunomide.

Primary action: suppress the activity of cells of the immune system.

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Antimalarial drugs

Examples of drugs: delagil (resohin, hingamin), plakventil (hydroxychloroquine).

Primary action: reduce the severity of symptoms and slow the progression of the disease.

Sulfonamides

Examples of drugs: salazopyridazine, sulfasalazine.

Primary action:

• Have a modifying effect on the course of the disease.
• Stop the worsening of symptoms.
• Suppress the production of aggressive agents.

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Means containing gold salts

Examples of drugs: aurothiomalate, aurofine.

Primary action:

• Suppress the formation and development of erosion and titers of rheumatoid arthritis.
• Help improve the general condition of the body.
• Eliminate the manifestations of "dry syndrome".
• They inhibit the development of children's seropositive rheumatoid arthritis.

Biological agents

Examples of medicines: emblemel, orentsia, rituxan, remiqad, kineret, humira.

The main action: it is genetically modified preparations that modify the reaction of enzymes of the immune system (biological reaction).

It is most effective to treat rheumatoid arthritis, prescribing several basic therapy drugs simultaneously, because they strengthen each other's action, speeding up the result. For example, the treatment regimens showed themselves perfectly:

1. Methotrexate and cyclosporine;
2. Methotrexate, sulfasalazine and hydroxychloroquine.

Methotrexate is the "gold standard" in the therapy of rheumatoid arthritis

Non-steroidal anti-inflammatory drugs are an emergency aid for relieving the pain syndrome and relieving the inflammation of the joints.

It is necessary to treat the disease with NSAIDs under the strict control of a rheumatologist.

It is necessary to adjust the daily dosage of the drug after the onset of the effect of the drugs of basic therapy.

With the help of non-steroid drugs, the disease itself can not be treated. But they effectively reduce unpleasant symptoms, thus greatly improving the quality of life of a person.

Effects of drugs: stop the pain syndrome and reduce inflammation in the tissues of the joints and periarticular bags.

Corticosteroids

Corticosteroids are saved in severe situations, when the manifestations of rheumatoid arthritis are so vividly pronounced that they do not allow a person without pain to perform a single movement. With them, you can treat pain and inflammation with high efficiency.

They are appointed with extreme caution, since corticosteroids are stress hormones.

When administered orally, they are able to deal a severe blow to all systems and organs, therefore, local formulations are used for the safe treatment of rheumatoid arthritis.

Corticosteroids, injected directly into the tissues of the affected joint, instantly stop pain, stop the inflammatory process and contribute to overall improvement in the patient's condition. But the therapeutic effect lasts no more than a month, and with the withdrawal of the drug all negative manifestations return, in most cases with redoubled force.

Examples of agents: prednisolone, triamcinolone, dexamethasone, methylprednisolone, betamethasone.

Active action:

• Instantly stop the pain.
• Stop the inflammatory processes in the tissues.
• Improve the general condition of the patient.

The injection of corticosteroids in the joint tissue allows you to quickly stop pain

LFK for rheumatoid arthritis

Forced movements, which cause the straining of the affected joints - are detrimental to the healing process.

But special exercises are needed that help to adapt the surviving working tissues to the new conditions of functioning and partially restore the function of the affected tissues.

Such exercises make the therapy of rheumatoid arthritis effective and progressive.

Exercises of physiotherapy exercises should not overload the joints and cause additional damage to the tissues. Their goal is to improve the nutrition of the tissues and restore the motor function of the joint.

In no case can not conduct training physical therapy in the acute period of any infectious disease, with respiratory failure and heart failure of 2 and 3 degrees.

Exercises exercise therapy in the treatment of rheumatoid arthritis - an effective means of reducing the morning restoration of movements, preservation of the remaining functional abilities of joints and partial restoration of lost.

The technique of carrying out exercises for the treatment of rheumatoid arthritis is chosen strictly individually. It is necessary to take into account the patient's condition, the possibility of affected joints and the risk of unintentional injuries.

Physiotherapy

Treatment for rheumatoid arthritis is performed with the application of procedures of physiotherapy. They reduce the activity of inflammatory processes, stop pain, contribute to the restoration of damaged tissues. Assign physiotherapy only after removing the pain syndrome and stopping inflammation.

Home treatment with folk remedies

Natural recipes in the treatment of rheumatoid arthritis are effective and safe.Most rheumatologists recommend to include in the treatment regimen decoctions, tinctures and ointments made from medicinal plants.

The first place in the treatment of rheumatoid arthritis at home is occupied by ordinary potatoes. The composition of this popular vegetable helps to increase the effectiveness of the basic treatment and helps the immune system to return to normal mode of operation.

Potatoes on kefir

Preparation: medium-sized potatoes on a grater. The resulting mass pour a glass of ordinary kefir.

Flowers of buttercup

Preparation: a handful of buttercup flowers (25-30 pcs.) Pound in a mortar until the appearance of juice.

Radish juice, honey and vodka

Preparation: 2 cups of juice, squeezed out of black radish, 2/3 of a glass of honey and half a glass of vodka, thoroughly mix until smooth.

Before using folk recipes, be sure to consult your doctor. Knowing all the nuances of the course of your illness, the specialist will help you choose the most effective tool, advise the most effective way of using it.

Be patient

Rheumatoid arthritis is a disease that does not choose the age of a person. It can occur in both the child and the pensioner.

Only an attentive attitude towards one's health, timely access to a rheumatologist, scrupulous fulfillment of all prescriptions and continuous treatment can relieve the negative manifestations, stop the processes of tissue destruction and make treatment for rheumatoid arthritis max. effective.

A source: http://SustavZdorov.ru/artrit/revmatoidnyj-lechenie-212.html

Treatment of rheumatoid arthritis - new generation drugs

Rheumatoid arthritis is an autoimmune disease that is chronic and lasts for a long time with periods of remission and exacerbations. This is one of the most severe chronic diseases, which is difficult to treat.

The exact causes of the development of this disease have not yet been established.

Scientists are constantly trying to develop effective treatment for rheumatoid arthritis - a new generation of drugs that act faster than their predecessors. In addition, such agents provoke fewer negative side effects in patients, better tolerated.

Modern treatment of rheumatoid arthritis

Therapy of this ailment is expressed in the use of the following drugs:

• anti-inflammatory;
• basic.

Nonsteroidal anti-inflammatory drugs relieve pain and other symptoms.

Basic drugs help slow the progression of the pathology or turn its course into a state remission, regulating directly the mechanisms of the development of the disease, suppress the work of the immune system.

Modern application of new generation of genetic engineering in rheumatoid arthritis allows to influence the function immunity, namely - suppress the production of cytokine cells that provoke inflammatory processes and erosive lesions joints.

The main advantage of biological agents is their ability to act solely on one group of immune components, without affecting other mechanisms.

Genetically engineered medicines for therapy in rheumatoid arthritis also include drugs with monoclonal antibodies to the surface receptors of B-lymphocytes - cells involved in the processes of joint destruction and provocation inflammations. These drugs also suppress the production of cytokines, but still at the early stages of their formation, "in the bud."

Cytokines

Cytokines are small peptide information molecules.

The cytokine is released to the surface of cell A and interacts with the receptor of adjacent cell B. Thus, a signal is transmitted from cell A to cell B, which triggers further reactions in cell B.

Their main producers are lymphocytes.

In addition to lymphocytes, macrophages, granulocytes, reticular fibroblasts, endothelial cells and other cell types secrete them.

They regulate intercellular and intersystem interactions, determine cell survival, stimulation or suppression of their growth, differentiation, functional activity and apoptosis, and also ensure the consistency of the action of the immune, endocrine and nervous systems under normal conditions and in response to pathological impact.

Cytokines are active in very low concentrations. Their biological effect on cells is realized through interaction with a specific receptor located on the cell cytoplasmic membrane. The formation and secretion of cytokines occurs briefly and is strictly regulated.

All cytokines, and now they are known more than 30, are divided into several independent groups according to their structural features and biological action. The grouping of cytokines by the mechanism of action allows us to divide the cytokines into the following groups:

• proinflammatory, providing mobilization of the inflammatory response (interleukins, TNFα, interferon γ);
• Anti-inflammatory, limiting the development of inflammation (interleukins, 0, TGFβ);
• regulators of cellular and humoral immunity - (natural or specific), possessing their own effector functions (antiviral, cytotoxic).

Spectra of biological activities of cytokines overlap to a significant degree: the same process can be stimulated in the cell by more than one cytokine.

In many cases synergism is observed in the actions of cytokines.

Cytokines - antigennotspecific factors, so the specific diagnosis of infectious, autoimmune and allergic diseases by means of determining the level of cytokines is impossible.

But the determination of their concentration in the blood gives information on the functional activity of various types immunocompetent cells; on the severity of the inflammatory process, its transition to the systemic level, and the prognosis disease.

Source of information on cytokines - Cytokines

List of new generation drugs for the treatment of rheumatoid arthritis

Preparations of a new generation for the treatment of rheumatoid arthritis can be conditionally divided into several varieties according to the mechanism of their action:

1. Interleukin-1 inhibitors:

2. Blockers of tumor necrosis factor or TNF-blockers:

• Remicade (infliximab);
• Enbrel (etanercept);
• Humirae (adalimumab).

3. Means that interfere with the work of B-lymphocytes:

4. Medications that suppress the activation of immunity T cells:

Consider some of these drugs in more detail.

The Kinneret (anakinra)

Kineret (anakinra) is included in the clinical and pharmacological group of immunosuppressants. This drug is included in the list of ONLS (under the Order of the Government of the Russian Federation No. 2782-r of 30.12.2014). This is an antitumor drug.

Selective blocker of interleukin (IL-1) receptors. Anakinra is an unglycosylated recombinant human antagonist of IL-1 receptors, interferes with the binding of IL-1 to the receptor.

It is used in the treatment of rheumatoid arthritis, a systemic autoimmune disease characterized by chronic polyarticular synovial inflammation caused by excessive production of pro-inflammatory factors by T cells, in particular interleukin-1.

Contraindications for this drug:

• Acute infectious processes.
• The state of immunodeficiency.
• Individual intolerance.
• Caution should be used for patients with chronic infectious diseases.

The drug is administered by subcutaneous injection into the hip or abdomen once a day in an amount of 100 mg.

The highest daily dose: 100 mg.

The highest single dose: 100 mg.

Anakinra blocks IL-1 receptors, eliminating the effect of interleukins. The drug is used in conjunction with basic drugs in the treatment of rheumatoid arthritis.

It is recommended to do subcutaneous injections at the same time of day.

In infectious diseases, the administration of the drug is canceled, after curing acute processes, injections continue until the clinical improvement of rheumatoid arthritis.

Remicade (infliximab)

Remicade is an immunosuppressive agent - antibodies monoclonal ATX:

Infliximab (remicade active ingredient) is a chimeric mouse-human monoclonal antibody, which binds with a high affinity to the soluble and transmembrane forms of TNFα, but does not bind to lymphotoxin alpha (LTa).

Treatment of patients with rheumatoid arthritis in active form, who had previously treated with basic anti-inflammatory drugs (DMAP), including methotrexate, was ineffective, as well as treatment of patients with severe progressive rheumatoid arthritis in active form who had not previously been treated with methotrexate or other DMAP.

Treatment is carried out in combination with methotrexate. Combined treatment with Remicade and methotrexate allows to reduce the symptoms of the disease, improve the functional state and slow the progression of joint damage.

Contraindications:

• hypersensitivity reactions to infliximab, other murine proteins, as well as to any of the excipients of the drug;
• severe infectious process, for example, sepsis, abscess, tuberculosis, opportunistic infections;
• chronic heart failure of III-IV functional class according to NYHA classification.
• pregnancy and breastfeeding;
• age less than 18 years (with Crohn's disease and ulcerative colitis - less than 6 years).

Caution should be applied:

• chronic or recurrent infections in the anamnesis, including with concomitant therapy with immunosuppressants;
• intensive therapy with immunosuppressants or long-term PUVA therapy in history;
• carrier of hepatitis B virus;
• demyelinating diseases;
• increased risk of developing malignant tumors due to smoking;
• malignant neoplasms in the anamnesis, continuation of therapy in patients with developed malignant neoplasms;
• chronic heart failure of I-II functional class according to NYHA classification.

In the treatment of rheumatoid arthritis with a new generation of Remicade, the initial single dose of the drug is 3 mg / kg intravenously.

Then the drug is administered in the same dose 2 weeks and 6 weeks after the first administration (induction phase), and every 8 weeks thereafter (maintenance phase of treatment).

Orence (abatacept)

Abatacept is an immunosuppressive drug related to selective immunosuppressants.

Abatacept is a soluble protein consisting of an extracellular domain antigen-4-cytotoxic T-lymphocytes (CTLA-4) bound to a modified Fc fragment immunoglobulin G1 (IgG1) human.

Abatacept is indicated for reducing symptoms, suppressing the progression of structural lesions, and improving the functional activity of adult patients with mild or severe active rheumatoid arthritis with insufficient response to one or more basic anti-inflammatory (such as methotrexate) or biological antirheumatic preparations.

Abatacept can be used in the form of monotherapy or in combination with basic anti-inflammatory drugs (for example, methotrexate).

Contraindications:

• Hypersensitivity to abatacept and / or any of the auxiliary components of the drug.
• Joint application with blockers of tumor necrosis factor.
• Pregnancy (no studies have been performed).
• Lactation period.
• Age before 6 years.
• Severe uncontrolled infections (sepsis, opportunistic infections), active infections (including tuberculosis) until control is established.
• Joint application with azathioprine, gold preparations and anakinro.

Abatacept should be used with caution in patients with recurrent infections; conditions predisposing to infections (diabetes mellitus), hepatitis; in elderly patients. The introduction of abatacept should be discontinued if a new serious infectious disease develops.

Abatacept is administered intravenously for 30 minutes at the doses indicated in the table.

Adults

After the first administration, the following doses are recommended after 2 and 4 weeks, and then every 4 weeks.

Patient weight	Dose	amount vials
<60 kg	500 mg	2
60-100 kg	750 mg	3
> 100 kg	1 g	4

Children aged 6 to 17 years

• Children with a body weight of less than 75 kg

The administered dose of abatacept - 10 mg / kg body weight - should be calculated individually, immediately before each administration of the drug.

• Children with a body weight of 75 kg and more

The drug is administered in the dosing regimen for adults. The maximum dose is 1000 mg.

A source: http://artroz-artrit.ru/artrit-preparaty-novogo-pokoleniya.html