INTENSIVE THERAPY FOR RHEUMATOID ARTHRITIS: IS IT REAL EFFICIENCY OR A NEED IN THE ABSENCE OF ANY ALTERNATIVE?

Abstract

Objective. To evaluate the efficiency of different intensive therapy (IT) regimens for rheumatoid arthritis (RA) in real clinical practice. Subjects and methods. The study enrolled 104 patients receiving different modalities of IT and 115 control patients having the standard basic therapy only. The time course of changes in the articular syndrome (Ritchie articular index, counts of tender and swollen joints, pain levels and global disease activity by the visual analogue scale, morning stiffness) was estimated in all the patients. Changes in the major laboratory parameters: erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and circulating immune complexes were studied in the comparable groups. The efficiency of IT was evaluated by the EULAR criteria from the changes in DAS 4 index and in ACR 20/ACR 50/ACR 70 response rates. Results. All IT modalities showed a rapid early clinical effect, the most evident changes in the major clinical and laboratory parameters being observed in the use of plasmapheresis synchronized with pulse glucocorticoid (GC) therapy. According to the EULAR criteria, improvement was achieved in 77,4% in the IT group versus 15,2% in the controls and, following 6 months, positive results remained in 60,6 and 26,8%, respectively. By the ACR criteria, 50% improvement was seen in 29,7% of cases after 3 months after IT and in 3.7% in the controls; after 6 months this persisted in 24,5 and 9,7%, respectively. Conclusion. Addition of IT to the complex management of RA rapidly reduces the activity of RA and alleviates its systemic manifestations, the effect of IT persisting for 6 months on average. However, the application of programs for intensification of treatment with GC and cytostatics in high doses cannot retard the progression of erosive arthritis.