Modern drug therapy for rheumatoid arthritis

Nosological classification (ICD-10)

• C34 Malignant neoplasm of bronchus and lung
• C40-C41 Malignant neoplasms of bones and articular cartilage
• C49 Malignant neoplasm of other types of connective and soft tissues
• C50 Malignant neoplasms of the breast
• C56 Malignant neoplasm of the ovary
• C58 Malignant neoplasm of the placenta
• C62 Testicular malignancy
• C69.2 Malignant neoplasm of the retina
• C81 Hodgkin's disease [lymphogranulomatosis]
• C91.0 Acute lymphoblastic leukemia
• L40 Psoriasis
• O01 Hydatidiform skid

Pharmacological groups of drugs for rheumatoid arthritis

Rheumatoid arthritis requires complex treatment aimed at relieving inflammation and pain, suppressing the immune response, healing erosions on the articular surfaces, restoring nutrition to the joint and periarticular tissues. Various pharmaceutical groups of medications for the treatment of arthritis serve this purpose.

Immunosuppressive drugs for the treatment of rheumatoid arthritis

Immunosuppressants are used as the main group of drugs for rheumatoid arthritis.

- drugs that selectively suppress the activity of certain immune cells.
Since immunosuppressants have different profiles, for rheumatoid arthritis, only drugs designed to suppress autoimmunity are prescribed
. They help relieve inflammation and pain, stop the destruction of articular surfaces, and in some cases, even give the joints a “delay” to recover.

Immunomodulators are always combined with anti-inflammatory drugs and chondroprotectors.

As a rule, basic therapy is taken once a week.

Basic drugs for the treatment of rheumatoid arthritis are used in courses or on an ongoing basis for life. Please note that in case of ARVI and other diseases, immunosuppressants should be stopped until complete recovery.

.

Immunosuppressants are available in tablets, capsules and injection solutions. The best effect is achieved by combining 2-3 basic drugs at the same time.

Nonsteroidal anti-inflammatory drugs for the treatment of rheumatoid arthritis

Nonsteroidal anti-inflammatory drugs

in the treatment of rheumatoid arthritis, they help reduce the activity of inflammatory mediators (prostaglandins, enzymes).
They relieve swelling and inflammation, relieve pain, normalize blood circulation and metabolism of tissues around the joint, and facilitate movement in the diseased joint. NSAIDs irritate the mucous membranes of the stomach and intestines, and therefore are used in short courses of 10-12 days to relieve exacerbations. This group of medications for the treatment of arthritis has only a symptomatic effect and does not help restore the joint or stop the progression of the disease
.

NSAIDs are available in the form of tablets, capsules, injection solutions, gels and suppositories.

Glucocorticoids

Glucocorticosteroids

(hormonal) drugs are used only in cases where the effect of NSAIDs is not enough to relieve pain.
Since such medications have serious contraindications and complications, rheumatologists recommend using them in short courses no more than 1-3 times a year
. In severe cases, it is possible to use prednisolone for up to 6-12 months. Their more frequent and prolonged use is justified only in case of a sharply unfavorable course of the disease, its rapid progression, or severe complications from basic therapy.

Glucocorticoids can only be taken as prescribed by a doctor and in strict accordance with the dosage, otherwise the condition of the joints may even worsen.

There are many types of drugs for rheumatoid arthritis

Chondroprotective drugs for rheumatoid arthritis

Chondroprotectors

is a group of drugs for the treatment of rheumatoid arthritis that contain glucosamine and/or chondroitin sulfate. They are helping:

1. Enrich synovial fluid, the quality of which suffers during the inflammatory process. The composition of synovial fluid, the natural lubrication of the joint, is directly related to its health. If the viscosity is insufficient, the lubricant does not ensure sliding of the articular surfaces and normal shock absorption of the joint. Its depletion leads to the fact that the cartilage tissue does not receive enough nutrients, loses its elasticity, dries out and cracks. At the same time, normal cartilage regeneration is also inhibited, because new cells grow unstable and are quickly destroyed.
2. Strengthen cartilage cells, making them more resistant to adverse factors. This helps to grow new cartilage tissue and even completely restore small areas of erosion on the cartilaginous lining of the joint. Thanks to chondroprotectors, the progression of the disease slows down. Maintaining and preserving cartilage helps delay the disability of rheumatoid arthritis for many years!
3. Avoid switching to heavier medications or delaying their use.

To achieve a lasting effect, chondroprotectors are taken in long courses of 3-6 months, 1-2 times a year. Since they have virtually no contraindications and cannot cause complications, this group of drugs remains one of the preferred ones in the treatment of rheumatoid arthritis.

Chondroprotectors are produced in the form of tablets and capsules, injections, sachets and gels. Artracam is considered one of the best chondroprotectors

.

Angioprotectors and microcirculation correctors

Microcirculation correctors

used as auxiliary drugs to prevent complications. On the quality of blood circulation, incl. in small capillaries, the nutrition of the joint depends. In severe cases, disruptions in the circulatory system and subchondral sclerosis of the articular surfaces can lead to death (necrosis) of the bone heads that form the joint.

Swelling and inflammation can cause compression of the articular walls

;
Vasculitis
(inflammation of blood vessels) is also common in rheumatoid arthritis

Antispasmodics and muscle relaxants

The inflammatory process in the joint also affects the soft periarticular tissues. Muscles and ligaments are no exception. Constant muscle tension accelerates muscle atrophy in rheumatoid arthritis due to their destruction and increases the feeling of fatigue. Spasms can also cause serious discomfort: intensify or cause pain (cramping pain), interfere with normal sleep, the patient’s movement and performance of household chores, and cause disturbances in fine motor skills.

New generation drugs for the treatment of rheumatoid arthritis

New generation drugs in the treatment of rheumatoid arthritis mean genetically engineered biological drugs that control the course of the disease. T.N. targeted therapy with synthetic drugs

lasts about 3-6 months from the moment RA symptoms are identified.

The use of new generation products is due to the fact that in rheumatoid arthritis, the cartilage is “self-damaged” by enzymes from the affected cells. Increased production of cytokines triggers a cascade reaction in cells, provoking chronic inflammation and, as a consequence, disability of the patient.

Modern biologics help slow down this process by blocking cytokines (messenger molecules that are responsible for the body's immune responses) or producing antibodies to them, inactivating T-lymphocytes, or otherwise preventing the transmission of signals to attacking immune cells.

In some cases, according to rheumatologists, it is possible to get by with new generation drugs for the treatment of rheumatoid arthritis.

Directions for use and doses

Inside, before meals, without chewing, with water; IM, IV (bolus, infusion), IV, intrathecal (subarachnoid). Doses are selected individually, depending on the disease, general condition and blood picture of the patient. Doses above 100 mg/m2 of body surface are administered only intravenously (the solution or concentrate is pre-diluted with a 5% glucose solution to a level of 10 mg (500-1000 ml) and under the protection of calcium folinate. Intrathecal - 0.2-0.5 mg /kg (8-12 mg/m2) every 2-3 days; after the disappearance (or reduction) of symptoms, the interval between injections increases to 1 week, then to 1 month; prophylactically - every 6-8 weeks. For psoriasis, psoriatic arthritis , autoimmune diseases - 10-25 mg orally, weekly (it is also possible to administer intravenously or intramuscularly at the same dose); initial dose - 2.5-5 mg, then the dose is increased to 7.5-25 mg/week (no more than 30 mg/week).

Distinctive signs of rheumatoid arthritis

Symptoms of rheumatoid arthritis are usually complex and affect more than just the joints. But most often the onset of the disease is announced by:

• pain and discomfort in fingers or toes;
• stiffness, increasing difficulty in flexing and extending joints, especially after exercise, in the morning, after a long, immobile rest;
• swelling of the affected joints, severe edema;
• redness, heated skin and other symptoms of inflammation over the affected joints;
• decreased endurance, increased fatigue - both in the affected parts of the body and in general;
• increased body temperature (37-38°C);
• weakness, chronic fatigue;
• difficulty breathing, shortness of breath at the slightest physical exertion;
• anemia, pallor of mucous membranes.

These symptoms may include pain in the abdomen and/or chest, inflammation of the uvea (uveitis), and skin rashes.

The first symptoms of the disease usually appear after a shock to the body: physical or psycho-emotional stress, infection, allergies, hormonal changes or exposure to other unfavorable factors.

Drugs for the treatment of rheumatoid arthritis at different stages

The specifics of treatment depend on how far the changes in the cartilage and bone tissue of the joint have gone

. Since many medications for rheumatoid arthritis, when taken for a long time, have a negative effect on the condition of internal organs, doctors are trying to move from safe drugs to potent ones.

Stage 1 of the disease

After stopping the first inflammation in rheumatoid arthritis, taking chondroprotectors

and
immunosuppressants
. This supportive therapy gives the body the opportunity to recover on its own.

NSAIDs

are used only in the acute phase of the disease.
Also, in the early stages of RA, long-term remission is possible, which is maintained not by the use of heavy drugs, but by following a diet. It is important to dress according to the weather, alternate periods of exercise and periods of rest, be less nervous, take vitamin courses 2 times a year
.

At stage 1 of the disease, glucocorticoids are never used

- they are indicated only in case of a destructive process with the formation of bone erosions. Antispasmodics, painkillers and microcirculation correctors, as a rule, are not required.

In the early stages of arthritis, it is important to maintain a moderate lifestyle and daily routine.

Stage 2 of the disease

At the second stage of the disease, rheumatologists usually add anti-inflammatory drugs (NSAIDs), angioprotectors, decongestants to chondroprotectors and immunosuppressants, and, in the presence of spasms, muscle relaxants. In addition to external agents (gels, ointments, creams, balms), systemic therapy drugs are added. If the course is unfavorable, new generation drugs for the treatment of rheumatoid arthritis are usually prescribed.

Stage 3 of the disease

Stage 3 rheumatoid arthritis is characterized by severe destruction of the joints, therefore basic therapy, drugs for the treatment of new generation rheumatoid arthritis, NSAIDs and glucocorticoids come first, and chondroprotectors are taken exclusively as an auxiliary supportive agent. Patients may also be prescribed additional medications to mitigate the side effects of the main therapy.