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Objectives: This article reports 1-year clinical outcomes of patients with rheumatoid arthritis (RA) receiving abatacept (ABA) therapy. Materials and methods: Patients (n=91) with high RA activity (DAS28 = 5.1 ± 1.0) and an inadequate response on synthetic DMARDs (mainly methotrexate, 70.3%) and biologics (mainly TNF-α inhibitors, 93%) were included in the study. The majority of patients were middle-aged (49 ± 13.5) womens, RF (72.5%) and ACPA (77%) positive, with moderate functional impairment - HAQ = 1.4 (0.9-2). ABA were administered IV, 10 mg/kg according to the standard scheme. The evaluation of the effectiveness of the therapy was carried out according to the EULAR / ACR 2011 criteria using SDAI, CDAI, HAQ and the intention to treat approach. Results: ABA led to a significant (p

Objective. To assess efficacy and tolerability of infliximab in pts with rheumatoid arthritis (RA) in real clinical practice. Materials and methods. 75 RA pts with high disease activity according to DAS 28 in 80% who received previous antirheumatic drugs without proper effect were included in an open clinical trial. DAS 28 and ACR criteria were used as primary outcome measures. Results. Infliximab administration provided significant clinical improvement in most pts. Already in a week after the first infusion 20% ACR improvement was achieved in 74% of pts. Significant improvement of all the main treatment effect parameters was achieved after the second infusion. ESR and CRP mean values normalized after the third infusion. Rheumatoid factor decrease was noted after 6 weeks. Mean values of tender and swollen joint counts significantly decreased but arthritis signs remained in a part of pts. Clinical remission was achieved in 4 (19%) from 21 pts completed a year’s course of treatment and in 4 pts the treatment was not effective. Serious adverse events requiring infliximab withdrawal (including infectious arthritis, hand phlegmon and bronchitis) appeared in 7 pts Conclusion. These results show high efficacy of infliximab and prove advisability of its administration in RA

Diagnosis of lesions of the spine and sacroiliac joints may be helpful in discrimination between early psoriatic arthritis (ePsA) and early rheumatoid arthritis (eRA).Objective. To assess the significance of inflammatory back pain (IBP), HLA-B27, and active sacroiliitis (ASI) confirmed by magnetic resonance imaging (MRI) for differential diagnosis of polyarticular ePsA and eRA.Materials and Methods. The study included 29 patients with ePsA (13 males and 16 females, mean age 36.52 ± 11.27 years, average duration of the disease 13.03 ± 9.77 months) and 25 patients with eRA (7 males and 18 females, mean age 52.68 ± 14.7 years, average duration of the disease 4.0 ± 1.72 months). Presence of IBP (according to the ASAS criteria) and HLA-B27 were assessed (in 27 patients with PsA and in 20 patients with RA); ASI signs were assessed based on the MRI data (bone marrow edema/osteitis). DAS, DAS28, M ± SD, Fisher's exact test, t-test, χ2, the Yule coefficients of association (Q: level from -1 to +1) and Phi were calculated; differences were considered to be statistically significant at p

Diagnosis of rheumatoid arthritis (RA) at the beginning of the disease is a difficult task especially due to presence of a large group of pts with “undifferentiated arthritis” (UA) i.e. with inflammation of one or more joints which does not comply with a definite nosology. According to clinical experience UA is quite a serious condition which during a year transforms in definite RA in at least one third of pts. In 2007 Van der Helm-van Mil et al. proposed special criteria (“prediction rule”) allowing predicting transforming UA intoRA by counting prognostic index (PI). PI6 means low and PI8 - high probability of RA 37development during 1 year. Objective. To assess possibility of using prognostic criteria for determination of transforma- tion of UA into RA in Russian pts. Material and methods. 93 pts (84,9% - female) with early (disease duration no more than 12 months) UA were included. Mean age was 44,3±15,2 years, mean disease duration – 128,9±82,1 days (4,3±2,7 months). 59,1% of pts had olygoarthritis, 26,9% were rheumatoid factor seropositive, anti-cyclic citrullinated peptide antibodies (ACCP) were revealed in 29%. Examination with above mentioned methods to specify the diagnosis was performed trice during 12 months: at baseline, after 6 and 12 months. Results. During a year of follow up RA developed in 39(41,9%) pts. Mean value of PI was 5,18±2,48 (median 5,02 [3,01; 7,02]). PI values in pts with disease transformation into RA during a year were significantly higher (6,55±2,33) than in the rest of pts (4,18±2,1), p

Objective. To assess frequency of immunogenetic (HLA-DRB I allels) and immunologic - anti-cyclic citrullinated peptide antibodies (ACCP), IgM rheumatoid factor (RF) - parameters and their significance as markers of early rheumatoid arthritis (RA). Material and methods. HLA-DRB 1 alleles, ACCP and IgM RF were evaluated in 95 pts with early RA who fulfilled ACR criteria 1987 with disease duration 2 years or less. In 85,3% of them disease duration was

Objective. To assess efficacy and safety of leflunomide in the treatment of early rheumatoid arthritis (RA). Material and methods. 30 pts with RA aged 18 to 67 years were examined. 17 pts with disease duration less than 6 months (mean 3,6±2,6 months) were included in group 1 and 13 pts with disease duration from 6 months to 3 years (mean 1,8+1,3 years) - in group 2. DAS 28, ACR criteria, patient's general health, pain, HAQ, Keitel functional test and laboratory indices were used as outcome measures. Leflunomide was administered 20 mg/day during 12 months. Results. Significant decrease of RA activity indices was achieved during 3 months in both groups. Group 1 pts showed progressive improvement during the whole period of the treatment. Group 2 pts had the most prominent decrease of activity after 6 months of the treatment. Later some of them showed tendency to deterioration of several parameters. In 10 (58,8%) pts of group I clinical remission was achieved by the 6th month. The treatment was stopped because of adverse events in 4 pts. Serious adverse events were absent. Conclusion. Leflunomide (arava) is a highly effective and well tolerated disease modifying drug for the treatment of early RA. Leflunomide was more effective in pts with disease duration less than 6 months.

Objective. To assess efficacy melatonin administered for correction of sleep disturbances in pts with rheumatoid arthritis (RA). Material and methods. 3-weeks randomized controlled study of melatonin (Melaxen, Unipharm) 3 mg/day (in the evening) in 20 RA pts with sleep disturbances was performed. Control placebo group included 10 pts comparable with study group. Effect of the drug on insomnia so as on the main clinical and laboratory indices of RA activity was scored. Results. To the end of follow up study group pts showed improvement of sleep quality in comparison with initial. Frequency of such insomnia signs as feeling of dissatisfaction with night sleep, tiredness persistence after sleep and unpleasant feelings during sleep significantly decreased. The general result of treatment with melaxen was assessed by pt and doctor as improvement or significant improvement in 47,4-63,2% of cases. Morning stiffness, swollen and tender joint counts so as pain intensity significantly decreased during treatment. Improper drug tolerability was noted in only one pt. Signs of insomnia and RA activity did not change in placebo group. Conclusion. Melatonin is an effective and safe drug for correction of sleep disturbances in RA pts. It also showed capacity to decrease inflammatory activity of RA.