Patients in the single-dose group

Patients in the single-dose group Modern therapy for rheumatoid arthritis and thyroid function
Autoimmune rheumatism characterized by symmetrical erosive arthritis (synovitis) and multiple extra-articular (systemic) manifestations. Is characterized by pain, joint dysfunction and steadily progressive joint deformities, irreversible damage to internal organs, leading to early disability (approximately one-third of patients are disabled within 22 years after the onset of the disease) and life expectancy Decrease (5-16 years on average).
This enables the use of basic anti-inflammatory drugs, mainly methotrexate, for active and strictly controlled treatments in the early stages of the disease, and the development of new genetically engineered biological drugs to selectively block the connection of important immune mechanisms. The increased frequency of occurrence of thyroid pathology can be explained by the common immune mechanism of the development of these diseases. Generally speaking, the prevalence of thyroid pathology in patients reaches 29%. In the context of modern treatment, domestic authors have rarely studied the thyroid function status of patients. The use of genetically engineered biological agents to treat patients with thyroid function is particularly important. There are no domestic and foreign studies on this subject, and these studies predict the relevance of this work.

Assessment and treatment of the patient’s thyroid function status. In the group of patients receiving biological therapy, all patients did not take thyroxine. According to the treatment method, patients were divided into five groups: rituximab-13 (26.5%) patients, tocilizumab-7 (16.9%), abatacept-3 (6.4%) and infliximab 4 (8.5)%), -22 (45.7%) patients (16-methotrexate, 3-leflunomide, 2-sulfasalazine, 2-pranicol). At the time of prescribing, all patients received methotrexate (at doses of 7.5-22 and 11-16 per week, respectively), and infliximab-1 patients received methotrexate at a dose of 13.5 per week. The dose of 2-leflunomide 11 is 22 mg per day. In the group of patients who started treatment for the first time, 16 patients received a weekly prescription of 7.5-16 methotrexate, 3 patients-leflunomide at a daily dose of 22, and 2 patients-sulfasalazine 2211 per day The dosage for 2 patients-221 per day. In all patients during the study, the standard parameters of joint syndrome were evaluated: the number of joint pain, the number of joint swelling, the duration of morning stiffness in minutes, the pain degree of the 111 visual analog scale and the patient’s General health), depending on you. The quantitative evaluation of activity is performed using the recommended index of 29 (disease activity score). Disease activity was assessed as low (29≤3.2), moderate (3.2 <29≤5.1) or high (29>5.1). Determine the patient's functional ability according to the classification of (functional category-) and the Stanford Health Assessment Questionnaire. According to the questionnaire, the degree of dysfunction is determined by the following points: from 0 to 0.5 points-population, from 0.5 to 1.0 points-lowest, from 1.0 to 2.0 points-medium, from 2.0 to 3.0 points-severe dysfunction. The laboratory parameters were studied: erythrocyte sedimentation rate, reactive protein level and rheumatoid factor. In addition, all patients were assessed for the levels of free thyroxine (4), free triiodothyroxine (3), thyroid stimulating hormone, thyroid peroxidase antibody (to), and thyroglobulin (to).
Use the 6.0 software package for the statistical processing of the results. Use tests to evaluate the significance of differences when comparing quantitative parameters. To compare proportions, use a contingency table, and then use the exact test or the χ-square test. The Pearson difference is considered significant, <0.6. Similarly, in the context of rituximab treatment, according to, the duration of morning stiffness,, and index, heart rate, heart rate, pain intensity and a significant positive dynamic change (<0.6). At the beginning of the study, in the group of patients receiving rituximab (= 13), 1 patient (8.3%) was diagnosed with subclinical hypothyroidism, and 1 patient (8.3%) had resistance and Anti-antibody. During treatment with rituximab, the level of patients with subclinical hypothyroidism returned to normal. The patient received clinical and laboratory remission according to the standard, and achieved a 71% improvement according to the standard. In patients who initially had high levels of anti- and anti-antibodies, their levels decreased during rituximab treatment. The patient achieved satisfactory results with an improvement of 51%.

Among patients who initially had normal thyroid antibodies during treatment with rituximab, one patient had an elevated antibody level (1 (8.3%)) and another patient had an elevated antibody level (1 (8.3%)) . These patients received a satisfactory response, an improvement of 22%.

Therefore, in the context of improved clinical and laboratory parameters, the function of the thyroid gland is improved and the antibody level of the thyroid gland is reduced. It was found that tocilizumab significantly reduced disease activity (<0.6) 6 months after starting treatment (Table 1). Similarly, in the context of tocilizumab treatment, according to, the duration of morning stiffness, and index, heart rate, heart rate, pain intensity and a significant positive dynamic change (<0.6). At the beginning of the study, in the group of patients receiving tocilizumab (=7), 1 (15.3%) was diagnosed with subclinical hypothyroidism with elevated levels of antibodies and 2 (29.6%) The patient's hyperparathyroidism level is elevated. To.

After several months of treatment with tocilizumab in patients with subclinical hypothyroidism, the level of thyroid antibodies decreased slightly. This patient achieved good results on the standard, but the increase was 71%. Subclinical hypothyroidism was diagnosed for the first time in a patient who initially had high levels of antibodies but normal antibody levels. At the same time, the disease activity according to the 29 index is still high, with satisfactory results obtained according to and 22% improvement according to according to. In the second patient who initially had higher antibody levels during tocilizumab treatment, their levels returned to normal. The patient was diagnosed in remission, which improved 71%.

Therefore, in the context of improved clinical and laboratory parameters, the function of the thyroid gland is improved and the antibody level of the thyroid gland is reduced. In patients with inadequate treatment, thyroid function decreases. In addition, in the context of abatacept treatment, according to, the duration of morning stiffness, and the index, heart rate, heart rate, pain intensity and the positive changes (> 0.6). After several months of treatment, all patients achieved good results (3 (101%)). Evaluation of the treatment effect according to the standard (Figure 2) showed that after 6 months of treatment, the parameters of all patients decreased by 22%, 51% and 71%.

At the beginning of the study, in the group of patients receiving (=3), 2 patients (67.7%) had elevated thyroid antibody levels (antibodies in one patient and antibodies in the other patient.).

In patients who initially had high levels of antithyroid antibodies during treatment with abatacept, the levels of anti-antibodies decreased and the levels of anti-triglyceride antibodies returned to normal. The patient received a remission according to the criteria, and according to a 71% remission. In another patient who initially had high levels of anti-antibodies after 6 months of treatment, the levels decreased but the anti-antibodies increased. The patient achieved good results, an improvement of 71%. Therefore, in the context of improved clinical and laboratory parameters, the level of antibodies against the thyroid is reduced. In the context of infliximab treatment, according to the morning stiffness duration, the index, the disease activity according to the 29 index, heart rate, heart rate, pain intensity and the positive changes (> 0.6).
The clinical assessment of the thyroid status of patients receiving infliximab (= 4) initially showed no thyroid dysfunction or elevated thyroid antibodies. After several months of infliximab treatment, a patient with subclinical hypothyroidism was first diagnosed. According to the standard, this patient has no effect. According to the standard treatment effect is 22%. The occurrence of subclinical hypothyroidism can be explained by the ineffectiveness of treatment, because the patient is not prescribed due to contraindications. Infliximab can only be used in combination with. At the beginning of the study, in the accepted patient group (= 22), 2 (9.5%) were diagnosed with subclinical hypothyroidism; 8 (39.1%) patients had elevated thyroid antibody levels (2 (9.5%) ) Patients-and antibody levels increased, 4 (21.0%)-only and 2 (9.5%)-to). In patients with subclinical hypothyroidism, the level drops slightly. According to the standard, there is no effect, an improvement of 21%. In another patient with subclinical hypothyroidism, the level returned to normal. The patient obtained good results, an improvement of 51%. The patients with elevated levels of anti-antibodies were initially diagnosed as subclinical hypothyroidism and had increased anti-antibodies. This patient has no effect on and.
In patients with initially high thyroid antibody levels, antibody levels return to normal. The level of in patients with good results and 51% improvement was decreased, while the level of in patients with no effect was increased.
In all patients who initially had high antibody levels, their levels returned to normal. At the same time, the patient was ineffective, an improvement of 21%. During the treatment, one patient's relative to the level decreased, but relative to the level increased, another patient's relative to the level decreased, and the third patient's relative to the level increased. The first patient was satisfied with the treatment effect of and improved by 51%, the second patient was satisfied with the treatment effect of and reached 21%, and the third patient did not achieve the effect of and.
After 6 months of treatment, the clinical and laboratory parameters of the patients receiving rituximab and tocilizumab were significantly improved (<0.6). Improvements in clinical and laboratory parameters were also observed in the group of patients receiving abatacept and infliximab (> 0.6). Sudan When comparing and evaluating the therapeutic effects of different biological agents based on the and standards, no difference in effect was found. The study showed that patients with subclinical hypothyroidism were initially found to have improved thyroid function, and the titers of antibodies against the thyroid gland decreased or normalized during treatment.

Modern basic therapies have a positive effect on patients' thyroid function status. Combination therapy of rheumatoid arthritis with rituximab and leflunomide (preliminary results from Russian registry) Scientific and practical rheumatology. -2111-1st-.17-21. Characteristics of thyroid status in patients with rheumatoid arthritis: author's abstract. . Kander. Honey. science. -, 2103. -24 pages. Eureka Mignon Specialita Single Dosing Modification