One of the most common and frequently occurring diseases today is rheumatoid arthritis. This is a systemic connective tissue disease that is characterized by chronic inflammation that occurs in the joint. The most common places where the disease is localized are joints such as the ankle, knee, ankles and hands.
As a result of untimely provision of appropriate treatment, a person begins to feel enormous discomfort, accompanied by loss of mobility in the joint and the subsequent onset of disability.
Today, a huge number of drugs have been developed for the treatment of rheumatoid arthritis, but the most effective and most frequently used are new generation drugs that are aimed at:
All new generation drugs are divided into several groups, namely:
At the initial stage of the course of the joint disease, the use of basic medications is prescribed that help eliminate 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 medications, you can quickly localize the symptoms that arise when a joint disease enters the active stage of progression, as well as slow down the destruction in the joints and tissues surrounding it.
The main medications belonging to this group are:
This medication is the most commonly used to get rid of various joint diseases. The substances included in its composition contribute to a significant slowdown and suppression of the processes of pathological division and growth of connective tissue (cytostatic).
The medicine belongs to the group of antimetabolites and is a folic acid antagonist. As a result of the slowdown and arrest of cell division, the synthesis and functionality of DNA renewal is inhibited. In addition, the drug Methotrexate has a small effect on the performance of RNA and protein in the human body.
The drug also has a pronounced immunosuppressive effect, even when using a small amount. In this regard, the majority of patients who used the medicine to treat this disease experience a period of stable remission, that is, complete disappearance of symptoms.
The drug is very well tolerated and practically does not contribute to the occurrence of unwanted side effects. The medicine is taken orally with a 12-hour interval between doses. After 14 days, the dosage is increased in order to achieve the desired result.
After a month or a month and a half, the patient feels significant improvements. The duration of therapy and the number of appointments depend on the severity of the disease and the severity of the symptoms provoked by it.
This drug was developed for the treatment of diseases of the connective tissue surrounding the joint. With its participation, the productivity of dehydrotate dehydrogenase, a substance directly involved in the synthesis of uridimonophosphate, is suppressed.
As a result, the production of pyrimidine nucleotides is inhibited and the autoimmune response changes. The medicine does not allow the disease to progress, thereby not affecting human phagocytosis. Leflunomide is recommended for use at all stages of rheumatoid arthritis.
After a two-month course of therapy, the patient feels significant relief. After six months, the joint disease stops progressing, swelling in the joints disappears, and the pain syndrome is eliminated.
The drug Arava is more effective than Methotrexate, since the same result can be achieved only after a year of 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 quantity, after which the dosage is reduced.
Biological medications are widely known and often used to treat rheumatoid arthritis. They contain agents that are specially produced proteins with the active participation of genetic engineering.
The substances are distinguished by precise selective effects on key moments of the inflammatory process reaction in comparison with basic agents. After their use, 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 disease, rapid progression and pronounced symptoms caused by it. This group of medications differs from basic drugs in the maximum speed of action.
When using biological drugs, a reduction in symptoms and relief of the general condition can be achieved within a week to two after starting treatment.
There are situations that a decrease in symptoms occurs a few days after using the medication. Sometimes the doctor prescribes these medications in combination. With the help of such a tandem, you can achieve the desired efficiency and results much faster.
The most well-known biological drugs for the treatment of rheumatoid arthritis are the following medications:
Infliximab is the newest and most popular drug that is intended to get rid of the symptoms of the disease as a whole. Once in the bloodstream, the substances that make up the drug bind as quickly as possible to the extracellular proteins TNF-alpha (which are directly involved in anti-inflammatory reactions) and together with them form a stable compound.
After using the medication, the reduction in the joint space occurs much more slowly and, as a result, the erosive process disappears. The drug is available in the form of a solution, which is intended for intravenous administration.
The duration of therapy is about 12 months. The dosage and number of injections are prescribed individually for each patient. At the end of using the drug Infliximab, the use of basic drugs is prescribed to achieve a more lasting therapeutic effect.
This medication has excellent anti-inflammatory effects and is an inhibitor of tumor necrosis factor alpha (TNF-?). TNF is actively involved in the occurrence of the inflammatory process in rheumatoid arthritis.
The product is available in the form of a lyophilisate, intended for the preparation of a solution that is injected under the skin at the site of the lesion. The absorption process after manipulation proceeds very slowly, and the maximum amount in the blood plasma occurs after 2 days. The duration of elimination is 80 hours.
To increase effectiveness, Etanercept is prescribed in combination with Methotrexate. The drug is injected deep under the skin 2 times a week. It is prohibited to use the medication during the period of bearing a baby and breastfeeding due to the fact that there is no data on any effect on either the expectant mother or the full development of her fetus.
Kineret is a new generation medicine, which is a recombinant antagonist of the interleukin-1 receptor. With the help of this effect, cartilage and bone are protected from destructive processes in them. In addition, unpleasant symptoms are relieved during the period of active progression of the disease.
The drug is not prescribed for patients with impaired normal functioning of the kidneys and liver and diseases of these organs (renal and liver failure). The drug is administered subcutaneously. The duration of treatment using the drug Kineret is prescribed depending on the stage of the disease.
Humira is a selective immunosuppressive drug. The components that make up the drug have the excellent property of binding to 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, the drug Humira helps to rapidly reduce the concentration of acute phase indicators of inflammation. The drug is used for subcutaneous injection. After administration, the medication is absorbed very slowly.
The maximum amount in the blood plasma occurs five days after the manipulation. The drug Humira is administered twice over 30 days. A positive property of this medication is that it does not contribute to the occurrence of various allergic reactions.
The main active ingredient of the drug is infliximab, which helps reduce symptoms resulting from the appearance of an inflammatory process in the connective tissue of the joint. In addition, it significantly improves its functionality and mobility.
Remicade is available as a solution for intravenous infusion. Very often the medicine is used in combination with Methotrexate. With the help of such a complex, you can stop the progression of rheumatoid arthritis and achieve a stable stage of remission.
The dosage is selected personally for each patient and is calculated using the formula 3 mg per kg of weight. The therapeutic effect is observed after 12 weeks of therapy. If an insufficient result occurs, treatment with this medication can be extended with a slight increase in dosage; such manipulation is possible only on the recommendation of the attending physician.
Before using any new generation drug, you must undergo an examination and obtain specialist advice on 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 training, and also eating foods rich in vitamins and minerals are recommended.
Modern drugs for rheumatoid arthritis relieve symptoms, inhibit the development of the disease and ultimately put it into remission. Medicines used include basic antirheumatic drugs, glucocorticosteroids, biological response modifiers, NSAIDs, and non-narcotic analgesics. Chondroprotectors, ASD-2 and other drugs are used as auxiliary medications.
The treatment regimen is divided into solving 2 main problems - stopping the development of the disease, inducing long-term remission and relieving accompanying symptoms. If eliminating the symptoms only alleviates the patient’s condition, then the main group of medications prevents further destruction of the joints and, as a result, disability. Biological and disease-modifying drugs play a key role in the treatment of rheumatoid arthritis. By influencing specific mechanisms, drugs lead to a fundamental effect on the disease, which preserves health and ability to work. It also prolongs the patient’s life by eliminating an autoimmune disease that causes systemic inflammatory processes in the body. Symptoms are controlled with corticosteroids, NSAIDs and non-narcotic analgesics.
When treating RA, very powerful medications are used that affect entire body systems. Precise adherence to dosages is necessary, which can only be prescribed by a specialized specialist. Violation of medical instructions is fraught with serious health consequences.
A heterogeneous group of drugs with a specific effect - they reduce the inflammatory process in rheumatoid arthritis, although in other types of this disease they do not show such an effect and inhibit further progression of the disease and joint deformation. They have an immunosuppressive effect, which is also one of the main disadvantages of these drugs. Basic therapy for rheumatoid arthritis brings good results if started in the early stages of the disease. As a result, the duration of treatment for RA ranges from 2 months to several years. Treatment of rheumatoid arthritis with gold is one of the oldest methods, and although there are more effective drugs, this group of drugs does not cease to be used in cases of resistance to other medications. Aurotherapy is most effective against seropositive RA. The following basic drugs are prescribed:
Medications that provide the best anti-inflammatory effect, relieve severe pain and relieve swelling. Perhaps the use of huge shock doses, pulse therapy, if absolutely necessary. Medicines with hormones are used for short periods during exacerbations, severe forms of the disease, or lack of progress in treatment with weaker drugs. They exhibit a large number of side effects, for example, they negatively affect cartilage tissue. Medical developments have shown that Prednisolone for rheumatoid arthritis in combination with Methotrexate shows good results. This technique has become widespread in inpatient treatment. The following hormonal drugs are used:
NSAIDs for rheumatoid arthritis are the best means for relieving inflammation and pain relief. Non-steroidal anti-inflammatory drugs are divided into 2 groups - COX-inhibiting drugs and selective medications of the new generation. The effectiveness of the effect is approximately equal, the main differences are in contraindications and side effects. The first group has a destructive effect on the gastrointestinal mucosa, so it is better to take the tablets after meals with a large glass of water. The second contributes to heart complications. They are presented in various forms, including tablets, and ointments, suppositories, and injections are also recommended. List of medicines for joint arthritis from group 1:
The following selective COX-2 inhibitors are used to treat RA:
They are used to relieve pain symptoms, as a primary or an auxiliary agent together with NSAIDs. They take these pills to maintain a dynamic lifestyle when pain suddenly increases. The following drugs are used:
The newest and most effective pharmacological agents in the treatment of RA. Biological drugs have a specific effect on certain mechanisms in the body. For example, modern anti-TNF drugs reduce necrotic processes in affected tissues, which are one of the sources of inflammation. Such targeted therapy causes significantly less harm than the immunosuppressive effects of basic drugs. Moreover, the effect from them occurs much faster - from 2 to 6 weeks after the start of treatment. All drugs are available in injection form. Due to the high cost, they are used for complications, severe forms of the disease, or when other treatment does not help. Biological therapy is carried out with the following drugs:
Also, in order to help the body, eliminate the side effects of medications or complications of rheumatoid arthritis, they take auxiliary medications for pain, blood pressure, anticoagulants, etc. For example:
Rheumatoid arthritis is a complex disease that lasts for years, the correct therapy of which requires special knowledge about the disease, its variants, types of combination therapy, etc. Any drug and non-drug treatment of RA should be under the supervision of a doctor.
There are various methods and treatments for RA. Basic includes DMARDs and biological products. At the same time, symptoms are relieved with NSAIDs and painkillers, and hormones are used if necessary. However, there are no best drugs. Immunity can occur to any medicine. You need to start treating rheumatoid arthritis as early as possible; it is advisable to take the first course before symptoms appear. This will shorten the treatment time, and will also significantly reduce the harm to health caused by the disease and the medications taken.
Rheumatoid arthritis is the most common pathology of joint tissue in people of any age. According to the World Health Organization (WHO), the number of people suffering from rheumatoid arthritis in the world reaches 1%, which is 64 million people. As a result of the high risk of disability associated with this pathology, active development of new generation drugs for the treatment of rheumatoid arthritis is underway.
The etiology of this pathology still remains unknown to science. The prospects for complete recovery of patients are doubtful. Thanks to the recent discovery of the role of the immune mechanism in the development of rheumatoid arthritis, treatment has become more effective. The main goals of treatment for rheumatoid arthritis are:
In addition to the tasks, it is necessary to follow a diet (limit the consumption of sweets and starchy foods), and begin taking prescribed medications immediately after diagnosis. Additionally, resort to general strengthening methods of treatment: exercise therapy, physiotherapy, massage, sparing the joints, and, if necessary, use surgical interventions.
All drugs used in the treatment of rheumatoid arthritis are divided into:
The choice of medication depends on the degree of activity of the process, as well as on the effectiveness and presence of side effects identified during treatment.
The standard initial treatment for rheumatoid arthritis is a combination of the drugs Methotrexate and Leflunomide. The effectiveness of Methotrexate is determined 5-9 weeks after the start of treatment. The positive effect directly depends on the dose. This medicine has been used for years. The therapeutic benefit of taking Leflunomide develops after 3-5 months.
The effectiveness of this drug will appear no earlier than after 3 months.
If side effects occur, change medications to:
In addition to immunosuppressants, gold (aurotherapy) is used in the treatment of rheumatoid arthritis. The use of gold preparations is based on the assumption of the infectious nature of the pathological process. Aurotherapy is prescribed to all patients with a similar diagnosis. A distinctive feature is the rapid achievement of results: subsiding of pain, reducing the activity of the pathological process and slowing down the rate of destruction of joints. The most common gold preparation is Aurothiomalate.
Types of newest drugs:
To date, the latest drugs have been developed in the treatment of rheumatoid arthritis. These drugs also belong to the group of immunosuppressants, but their effects are more selective and gentle on the immune system.
In addition to immunosuppressants, biological agents are being actively developed. By blocking individual parts of the immune system, biological agents prevent the production of destructive factors.
List of new generation drugs for the treatment of rheumatoid arthritis:
The drugs Enbrel and Humira were the first in the group of biological agents. The mechanism of their effectiveness is based on blocking tumor necrosis factor. In the absence of positive dynamics while taking these drugs, Remicade, Orenzia, and Kineret are prescribed. The action of these dosage forms is based on preventing the production of anti-inflammatory cytokines.
Newer drugs to treat rheumatoid arthritis have fewer side effects. The effectiveness of these dosage forms has been established experimentally. However, until the exact cause of rheumatoid arthritis is discovered, it is not worth talking about 100% effectiveness of these remedies.
Treatment of rheumatoid arthritis is complex and can last for several years, so medications that are more effective are constantly being developed, and so-called new generation drugs are becoming popular.
Such medications are well tolerated and have a quick effect on sore joints. This means that a period of deep remission of rheumatoid arthritis or polyarthritis can be achieved faster.
But modern medicines used to treat rheumatoid arthritis may also be suitable for other joint and tendon conditions. For example, the anti-inflammatory drug Nimesil acts very effectively in chronic glenohumeral arthritis, quickly relieving pain and swelling of the connective tissues of the shoulder.
Over many years of fighting rheumatoid arthritis, certain standards of treatment have been developed. First of all, this is the use of the following groups of medications:
In the acute course of the disease, it is worth starting treatment immediately, since there is a danger of irreversible processes appearing in the affected cartilage, such as the formation of replacement tissue - pannus. Such neoplasms can permanently immobilize the joint. This can be avoided thanks to modern means:
Compresses using Dimexide, Menovazin or ASD-2 will help in treatment.
A constantly depressed state with signs of fever, which impairs the quality of life, can be easily corrected with the help of Nimesil. But only the doctor decides which complex is suitable for the patient, and whether it is necessary to include antibiotics in therapy.
First of all, these are drugs that affect the very nature of rheumatoid periarthritis of the joints, gradually eliminating it. These are the following medications:
The first of the two listed groups belong to traditional methods of combating polyarthritis, the latter represents modern developments.
Drugs that suppress the synthesis of antibodies that are involved in the formation of an autoimmune reaction. A new generation of drugs in this group:
Their use involves long-term use from one to three years. Accumulating in the body, they leave a lasting effect even after their withdrawal.
The active ingredient of the drug Methoject is methotrexate, it is an immunosuppressant, available in the form of tablets. It delays the development of structural damage to cartilage tissue. This is perhaps the best remedy for arthritis and periarthritis. The method of using Metoject is very convenient, since the patient is asked to take only 1 tablet once a week. Noticeable improvements will appear after 1.5 months. And steady progress is evident within six months. There is only one limitation: on the day of taking Metoject you should not drink NSAIDs.
The drug also prevents the growth of replacement tissue - pannus. If unpleasant sensations from the gastrointestinal tract occur, switch to intravenous infusion of the drug, following the instructions. The medicine is effective for glenohumeral periarthritis. The use of subcutaneous injections of Humira increases the therapeutic effect of Metoject. With all the advantages of Metaject, its prices are quite low.
This drug is an alternative to Metoject if it caused many side effects. But the price of Leflunomide is higher. It is prescribed, as a rule, for severe, rapidly progressing disease with pronounced destruction of the joints. Leflunomide begins to act quickly, suppressing the inflammatory process and the formation of pannus. Judging by the reviews, Leflunomide is actively used in the treatment of rheumatoid periarthritis. It goes well with Nimesil, as well as Plaquenil and Immard.
The most expensive of modern immunosuppressants, but also the fastest. It is used in extreme cases when other types of this group of drugs, for example, Leflunomide, have not helped, as it has many side effects. Available in tablet form.
These are antimicrobial and anti-inflammatory agents. Their antimicrobial properties are not inferior to antibiotics. They perform well in the treatment of polyarthritis, arthrosis, as well as glenohumeral periarthritis. Used in combination with Leflunomide or Metoject, enhancing their effect. Sharing with Nimesil and Metipred is not recommended.
NSAIDs are non-steroidal anti-inflammatory drugs. Among the popular drugs in this group are the following drugs that are suitable for stopping the inflammatory process in the joints:
In addition to the traditional use of Aspirin tablets, pharmaceutical companies also offer a broad-spectrum agent - Nise, which is produced in tablets, and Nimesil in the form of tablets or powder. Judging by reviews, such drugs effectively relieve pain, relieve inflammation, and normalize body temperature. Nimesil should be taken with caution: according to the instructions, only 2 sachets can be used per day, otherwise kidney failure may develop.
Diclofenac can be used in the form of injections or ointments. It fights inflammatory processes directly in cartilage tissue. Its combination with Metipred or chondroprotector Don, as well as with antibiotics, for example Bicillin, is well tolerated.
NSAID drugs combine well with Plaquenil and Immard. Often they are used in a treatment regimen only with chondroprotectors, such as Dona, Artra. This combination is used for uncomplicated glenohumeral periarthritis.
In the practice of treating rheumatoid arthritis, the following drugs have been used for quite a long time:
They go well with other medications for arthritis, such as Dona, Artra, Metipred.
They began to be used back in the days when it was believed that arthritis was an infectious disease and, accordingly, they began testing drugs from similar areas of treating infections. Plaquenil, Immard and Delagil immediately showed their effectiveness in treating joints too. But, despite good reviews about the absence of side effects, they are characterized by too slow results.
The drug Plaquenil (active ingredient hydroxychloroquine) is used in the treatment of glenohumeral periarthritis, rheumatoid arthritis of the knee or elbow joints. It has a mild effect and is suitable for the treatment of chronic, sluggish processes. Along with Immard, it has few side effects. But the result of treatment with Plaquenil or Immard, judging by the instructions, occurs in at least six months. Combines well with the drug Leflunomide.
Drugs that act directly on cartilage tissue. They are directly involved in blocking the mechanisms of pannus. This group of drugs has proven itself in the fight against arthritis, arthrosis and periarthritis, for example, of the shoulder joint. And a disease such as rheumatoid arthritis of the hands can only be treated with the use of chondroprotectors, such as Dona, and small doses of NSAIDs, for example, Nimesil. The most popular chondroitin preparations are:
Chondroprotectors can be combined with the following medications:
They do not reduce their activity at all, enhancing the bioavailability of other agents.
These are hormones of the adrenal cortex, which have pronounced properties to suppress the synthesis of certain substances and enzymes, as well as block allergic and autoimmune reactions. This group of drugs includes:
These drugs are widely used in the treatment of severe forms of rheumatoid polyarthritis. But they should be used with caution, strictly according to the instructions, so as not to cause a strong decline in immunity.
The drug Metipred is the most modern representative of the GCS group with a low percentage of contraindications. It is used to treat seriously ill patients for whom NSAIDs have become ineffective. Metypred is especially effective for complications of the disease.
The use of modern means is expected to reduce the duration of treatment with high rates of effectiveness. A small number of side effects is also an advantage of the new generation of drugs.
I worked too hard in the garden, the doctor diagnosed me with glenohumeral periarthritis and prescribed the drug Dona. And with the help of Nimesil, he advised me to relieve pain. Quite a bit of time has passed, but I no longer feel pain!
Sinko Elena, 45 years old.
My knees had been aching for a long time, and my temperature periodically rose. It turned out to be rheumatoid arthritis. I started a course of a new generation of drugs: Metipred, Leflunomide, Plaquenil and Dona. I feel much better.
Odintsova Maria, 38 years old.
When I was diagnosed with periarthritis of the leg joints, I thought that was the end. But using Metojekt, Immard and Dona tablets literally got me back on my feet. I started running in the morning.
Science is constantly searching for and creating drugs that could solve the problem of life-threatening illnesses, chronic or incurable diseases. Their list, along with malignant tumors, HIV infection, and diabetes, is supplemented by rheumatoid arthritis, the treatment options for which will be discussed in this publication.
Rheumatoid arthritis is an inflammatory pathology of an autoimmune nature that destroys joints and, in later stages, internal organs. Due to some factors (genetics, indirect influence of infections, etc.), the immune system becomes overly active, beginning to attack healthy cells, recognizing them at the molecular level as foreign. As a result, inflammation develops.
The basis of therapy is NSAIDs, corticosteroids and basic drugs. Let's look at them.
The NSAID group is the drugs of choice; they are prescribed first because, in comparison with basic and hormonal drugs, they have fewer side effects. They are available in the form of capsules, tablets, injection solutions and ointments. Action – inhibition of inflammatory mediators and relief of pain. The most famous drugs:
Corticosteroids have a more pronounced anti-inflammatory effect and relieve joint pain. Due to the negative effect on the body, they are prescribed with caution, and the prescribed dosage must be strictly followed. Injections into the joint cavity are especially effective. Examples of drugs are Prednisolone, Dexamethasone.
These include gold salts, sulfonamides and cytostatics (Azathioprine, Methotrexate, Sulfasalazine). These medications inhibit the activity of the immune system, stopping the inflammatory process. The basic therapy group also includes antimalarial drugs and D-penicillamine, but they are practically not used at present.
Gels, creams and ointments for rheumatoid arthritis help relieve pain and relieve swelling and complement oral medications. Examples of funds:
The main effect of these drugs is anti-inflammatory, analgesic, and antipyretic. Let's consider the types of non-steroidal drugs for inflammation in rheumatoid arthritis.
Drugs in this group inhibit both types of inflammatory mediators - COX-1 and COX-2 - and are also called non-selective. Main representatives:
The first NSAID drug discovered was Aspirin (1897). In addition to suppressing COX, it prevents the formation of blood clots and is effective in preventing complications from the heart and blood vessels.
They have a pronounced anti-inflammatory effect. Names of drugs:
Attention! Let me remind you that if you have any problem, you can seek advice from our specialists.
Attention! NSAIDs are contraindicated for peptic ulcers, poor blood clotting, pregnancy and breastfeeding, and kidney pathologies.
Non-steroidal drugs are available from pharmacies without a prescription, but consultation and prescription by a doctor are required. Self-medication for rheumatoid arthritis with NSAIDs alone is unacceptable, since they do not treat the disease, do not affect the autoimmune mechanism, but only relieve pain, swelling and reduce inflammation.
Be sure to watch videos about dangerous combinations of NSAIDs with other medications.
In the last century, the Nobel Prize was awarded for the discovery of the effectiveness of these drugs for the treatment of rheumatoid arthritis. But after this it became clear that the use of glucocorticosteroids has important limitations.
Medical practice has shown that prolonged use and large dosages of GC lead to the development of serious side effects on the part of internal organs, skin and mucous membranes, since they have a strong toxic effect.
High doses of glucocorticosteroids (more than 30 mg per day) are prescribed strictly under certain circumstances:
Potentially preventable or manageable side effects of GCs include glaucoma, diabetes, peptic ulcers, heart failure, osteoporosis, hypertension, acne, and sleep problems.
Irreversible and uncontrollable consequences of hormonal treatment:
The doctor selects low and medium dosages based on the characteristics of the rheumatoid process in a particular patient. They are mainly prescribed in combination with basic therapy for destructive changes in the joint (bone erosions). If the inflammation has not spread beyond the synovial membrane, then the basis is NSAIDs and basic drugs. Severe synovitis allows intra-articular injections of HA.
This is the main drug from the group of glucocorticoids prescribed for rheumatoid arthritis. It is considered a reference, that is, the dosage of other GCs is compared with it. For example, 10 mg of prednisolone corresponds to 1.5 mg of Dexamethasone or 8 mg of Methylprednisolone.
The minimum therapeutic dose is 0.5 mg, the maximum is 10-15 mg. As with all GCs, the dosage is gradually increased and just as slowly decreased. It is usually recommended to take the tablets with meals, and take antacids between meals to protect the stomach.
Its activity against inflammation is 5 times stronger than Hydrocortisone, inhibits leukocytes and tissue macrophages (immune cells). For rheumatoid arthritis and synovitis, it is prescribed in the form of injections into the joint or soft tissues or in the form of tablets.
Glucocorticoids reduce capillary permeability and maintain the tone of large vessels (arterioles). HAs affect the blood composition as follows:
Attention! An important condition when prescribing GC is the absence of high blood pressure.
Side effects in relation to the cardiovascular system include arterial hypertension, bradycardia (slow heart rate), heart failure, arrhythmia, thrombosis, myocardial rupture.
Arthritis hormones work by reducing inflammation in the joints through suppression of immune cells and an anti-inflammatory effect.
This includes five groups of drugs: cytostatics, gold drugs, sulfasalazine, antimalarials and D-penicillamine. We will consider only the first three, since the remaining two are now practically irrelevant.
Main representatives of the group:
They are considered one of the best remedies for the treatment of arthritis - rheumatoid and psoriatic. Pronounced effectiveness is observed in 80% of cases. Most effective for rapidly progressing inflammation.
Important! Methotrexate and NSAIDs are not taken on the same day; it is also important to take folic acid when treating with this drug.
The two main representatives are Aurothiomalate (trade names Myocrysin, Tauredon, Crizanol) and Auranofin. Used since the first half of the last century. The appearance of cytostatics has pushed them into the background, but gold compounds are still prescribed if Methotrexate does not have an effect and there are no contraindications.
On a note! The advantage of these drugs is that they can be used for many concomitant chronic pathologies and oncology.
They are most effective in the initial stages and with the rapid progression of rheumatoid arthritis and the early appearance of subcutaneous nodules and erosions on the surface of the bones. In case of seronegative variant they are practically not used.
Together with Saladopyridazine, it belongs to the group of sulfonamides. Somewhat less effective than gold salts and cytostatics - long-term use is required for a therapeutic effect (at least six months). The advantage of sulfonamides is that they are much better tolerated. Side effects are rare and reversible.
Locally, the pathology is treated with ointments and intra-articular injections.
Creams, gels and ointments can provide relative relief for joint inflammation:
Their effect is weak and short-lived, since a small amount of the active substance reaches the joint.
Usually performed using glucocorticosteroids - Flosteron, Diprospan, Metipred, Kenalog, etc. The advantage is the speed of action. Indicated in the early phase of inflammation with severe pain, they should not be done often. One injection usually allows you to forget about the pain syndrome for 2-3 weeks.
They act specifically on active participants in autoimmune inflammation - on cells and on receptors. These are the latest developments in medicine.
Another name for the drug is Adalimumab, the drug is produced in Germany. Part of the group of recombinant immunosuppressants, it inhibits immune inflammatory reactions. This medicine is a monoclonal antibody that is created synthetically by copying the human IgG1 peptide chain. The drug is effective for rheumatoid, psoriatic arthritis, and ankylosing spondylitis.
One of the first modern drugs for the treatment of RA, created using genetic engineering technology. It is an inhibitor of interleukin-6 receptors, a biological compound that is directly involved in autoimmune inflammation.
The trade name of the drug is Anakinra. Indicated for the treatment of moderate stage RA and in severe cases, if basic treatment has not brought results.
Attention! Kineret is not used to treat patients under 18 years of age, and its main side effect is local allergies and the addition of serious infections.
The drug is administered subcutaneously. It is a recombinant form of human interleukin-1 (IL-1) receptor antagonist, a selective blocker.
Medicine does not stand still, and discoveries in the treatment of serious diseases are encouraging.
Having studied the news of the latest discoveries and patented drugs, we have compiled a list of the latest drugs for the treatment of rheumatoid joint damage:
Great hopes are placed on new developments of drugs for rheumatoid arthritis, carried out in Israel and the USA. Harvard Medical School is testing a complex of monoclonal antibodies called Anti-CD3. And Israeli scientists are researching the effectiveness of glycolipid compounds.
The medicine BCD-121 was invented in Russia (developed by the biotechnological company BIOCAD). This is a monoclonal antibody with dual specific action. It blocks two proteins at once in the autoimmune reaction - tumor necrosis factor and interleukin.
The drug Sarilumab (Kevzara) was created in the USA. These are monoclonal antibodies that inhibit Intelikin-6. Studies have found greater effectiveness of the drug compared to Adalimumab.
Genetic engineering drugs and other modern developments show high efficiency. They can be called the best options today. The only problem so far is the high cost and inaccessibility on a mass scale.
Therefore, if we approach it from a practical point of view, the real treatment option for the majority remains basic medications, NSAIDs and glucocorticosteroids.
Of course, we should not forget about proper nutrition, therapeutic exercises and physiotherapy, which are an important and necessary addition to drug therapy for RA.
Rheumatoid arthritis is classified as a disease for which medications prescribed by a doctor can be received free of charge under a regional benefit. Disabled people with a social package also have the right to receive medications.
A doctor's story about biological treatments for rheumatoid arthritis.
Drug treatment of rheumatoid arthritis includes the use of NSAIDs, glucocorticoids and basic drugs. Among the newest drugs are genetic engineering developments (monoclonal antibodies), but they are expensive and are not yet available to most. All medications must be prescribed by a doctor, since self-medication of RA is unacceptable.
The monoclonal antibody sarilumab binds to soluble (sIL-6R) and membrane-bound (mIL-6R) interleukin 6 receptors (IL-6R), inhibiting signals mediated by the latter. Interleukin 6 is a pleiotropic proinflammatory cytokine synthesized by T and B cells, lymphocytes, monocytes and fibroblasts. It is involved in a wide range of physiological processes, including activation of T cells, induction of immunoglobulin secretion, triggering the synthesis of hepatic acute phase proteins, stimulation of proliferation and differentiation of hematopoietic progenitor cells. Interleukin 6 is also synthesized by synovial and endothelial cells, leading to local accumulation in joints affected by inflammatory conditions such as rheumatoid arthritis.
The Phase III MOBILITY clinical trial, which included 1,197 patients with moderate-to-severe active rheumatoid arthritis with inadequate clinical response to methotrexate, compared subcutaneous Kevzar plus methotrexate versus placebo alone.
At 24 weeks of therapy, significant improvement in the ACR20 criterion was demonstrated (at least a 20% improvement in rheumatoid arthritis activity score, as assessed by the American College of Rheumatology). Thus, in the group that was prescribed sarilumab at a dose of 200 mg, 66% of patients reached the specified level; at a dose of 150 mg - 58%; placebo - 33%.
At week 52 of the therapeutic course, those receiving Kevzara showed significantly less radiographic progression of structural damage measured by the modified total Sharpe method (TSP): respectively, 0.25; 0.90 and 2.78.
At week 16 of treatment, the sarilumab group showed greater improvements in functional status relative to baseline, according to the Health Assessment Questionnaire-Disability Index (HAQ-DI): -0.58; –0.54 and –0.30 respectively.
The Phase III TARGET clinical trial, which enrolled 546 patients with moderate-to-severe active rheumatoid arthritis with insufficient clinical response or intolerance to one or more tumor necrosis factor (TNF) antagonists, compared Kevzar (200 mg, 150 mg) versus placebo - against the background of disease-modifying drugs (methotrexate, sulfasalazine, leflunomide and/or hydroxychloroquine).
At week 24 of therapy, 61%, 56% and 34% of participants had an ACR20 response. At week 12, the HAQ-DI score was -0.49; –0.50 and –0.29 respectively.
Kevzara comes with a black box warning in the instructions because there is a high risk of developing serious infections with subsequent hospitalization or death. The most common negative side effect was neutropenia (7–10% of patients versus 0.2% in the placebo group).
The wholesale list price (that is, excluding discounts and discount programs) for Kevzara is stated at $39,000 per year, which, according to Sanofi, is a third lower than that for the two most common TNF inhibitors used in medicine. therapy for rheumatoid arthritis - Humira (adalimumab) and Enbrel (etanercept) by AbbVie and Amgen/Pfizer, respectively.
Mechanism of action of Kevzara (sarilumab).
It will not be easy for Kevzara, given the drug saturation of the rheumatoid arthritis market and the strong positions of the current top players. Thus, in 2016, sales of the TNF inhibitors Humira, Enbrel, as well as Remicade (infliximab), which is backed by Johnson & Johnson, amounted to 16. 08; 9.25 and 6.18 billion dollars.
Meanwhile, Sanofi and Regineron are not discouraged: the market tends to change dynamically, and patients often switch between different drugs, trying to choose the one that most stabilizes their disease.
Again, multiple clinical trials comparing the effectiveness of sarilumab versus Humira found the former to be superior to the latter. Thus, in the SARIL-RA-MONARCH studies among 369 patients with active rheumatoid arthritis, adequately unresponsive, intolerant to basic drugs or unresponsive to methotrexate, the disease was assessed according to the DAS28-ESR index, which considers tenderness and swelling of 28 joints and erythrocyte sedimentation rate .
The sarilumab group showed superiority over the adalimumab group: changes in DAS28-ESR at week 24 of therapy were -3.28 versus -2.20. The DAS28-ESR remission rate was recorded at 26% versus 7%. In addition, the ACR20 indicator came out at 72% versus 58%, the more difficult to achieve ACR50 - at 45% versus 29%, and finally the “incredible” ACR70 - at 23% versus 11%. Finally, improvements in the HAQ-DI index were recorded at -0.61 versus -0.43, respectively.
Direct competitors of sarilumab are Actemra/RoActemra (tocilizumab) and the not yet approved sirukumab, a regulatory decision on which will be made by the end of September - they similarly target the interleukin 6 signaling pathway. These drugs are being studied Roche/Chugai Pharmaceutical and Johnson & Johnson/GlaxoSmithKline.
There is an opinion that Kevzara will cost about 15% less than Aktemra. And this is important, given that the latter has been used successfully for many years, having been approved in January 2010.
Among the relatively new drugs against rheumatoid arthritis, it is also worth noting the Janus kinase 1 and 3 (JAK1 and JAK3) inhibitor developed by Pfizer, Xeljanz/Jakvinus, tofacitinib, registered in November 2012.
Industry experts estimate that sarilumab will reach annual sales of $1.8 billion by 2020.
Sanofi is struggling with its anti-diabetes drug business, facing both tough competition and pricing pressure. That's why it is important for the French pharmaceutical giant to diversify its activities - and expanding its immunological portfolio of drugs can help with this. For example, at the end of March, Dupixent (dupilumab) was launched for the treatment of moderate-to-severe eczema (atopic dermatitis).
It is interesting for Regineron to explore other approaches, not just the top-end Eylea (aflibercept) against age-related macular degeneration.
Again, the partners did not receive the desired return from the joint hypocholesterolemic Praluent (alirocumab), a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, which faced patent attacks from Amgen and its PCSK9 inhibitor Repata ( Repatha, evolocumab).