rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2016-557-571rsp-2302Research ArticleПРОГРАММА НЕПРЕРЫВНОГО ПОСЛЕДИПЛОМНОГО ОБРАЗОВАНИЯ ВРАЧЕЙPOSTGRADUATE PROGRAM OF CONTINUING MEDICAL EDUCATIONФАРМАКОТЕРАПИЯ РЕВМАТОИДНОГО АРТРИТА: РОССИЙСКИЕ И МЕЖДУНАРОДНЫЕ РЕКОМЕНДАЦИИPHARMACOTHERAPY FOR RHEUMATOID ARTHRITIS: RUSSIAN AND INTERNATIONAL GUIDELINESНасоновЕ. Л.NasonovE. L.

Евгений Львович Насонов - заведующий кафедрой ревматологии ИПО, академик РАН, профессор, доктор медицинских наук.

1115522 Москва, Каширское шоссе, 34А; 2119991 Москва, ул. Трубецкая, 8

Evgeny Nasonov -Department of Rheumatology, Institute of Professional Education.

134A, Kashirskoe Shosse, Moscow 115522; 28, Trubetskaya St., Build. 2, Moscow 119991

sokrat@irramn.ruНаучноисследовательский институт ревматологии имени В.А. Насоновой; Первый Московский государственный медицинский университет имени И.М. СеченоваРоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical UniversityRussian Federation201609122016545557571Copyright © Насонов Е.Л., 20162016Насонов Е.Л.Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2302

В лекции рассмотрены современные тенденции, касающиеся стратегии фармакотерапии ревматоидного артрита (РА), в свете рекомендаций Европейской антиревматической лиги (EULAR),  Американской коллегии ревматологов (ACR) и Общероссийской общественной организации «Ассоциация  ревматологов России» (АРР). Подчеркивается важнейшая роль стратегии терапии РА, основанной на принципах «Лечение до достижения  цели» (Treat to Target – T2T), ключевое место в реализации которой занимает ранняя  активная контролируемая  терапия метотрексатом (МТ). Обсуждается место в терапии глюкокортикоидов и особенно  генно-инженерных биологических препаратов, рациональное применение которых в комбинации с МТ позволяет добиться ремиссии  у большинства больных.

The lecture considers the present trends in the strategy of pharmacotherapy for rheumatoid  arthritis (RA) in the light of the guidelines by the European  League Against Rheumatism, the American College of Rheumatology and the All-Russian Public Organization  "The Association of Rheumatologists  of Russia". It emphasizes the most important  role of the treat-to-target RA treatment strategy, the key place of which is occupied by early controlled  active therapy with methotrexate (MT).  The therapeutic  place of glucocorticoids  and especially biologic agents, the rational use of which in combination  with MT allows a remission to be achieved in most patients,  is discussed.

ревматоидный артритметотрексатглюкокортикоидыгенно-инженерные биологические препаратыремиссияrheumatoid arthritismethotrexateglucocorticoidsbiologic agentsremissionReferencesНасонов ЕЛ, Каратеев ДЕ, Балабанова РМ. Ревматоидный артрит. В кн.: Насонов ЕЛ, Насонова ВА, редакторы. Ревматология. Национальное руководство. Москва: ГЭОТАР-Медиа; 2008. С. 290-331 [Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Nasonov EL, Nasonova VA, editors. Revmatologiya. Natsional'noe rukovodstvo [Rheumatology. National guidelines]. Moscow: GEOTAR Media; 2008, P. 290-331].Насонов ЕЛ, Каратеев ДЕ, Балабанова РМ. Ревматоидный артрит. В кн.: Насонов ЕЛ, Насонова ВА, редакторы. Ревматология. Национальное руководство. Москва: ГЭОТАР-Медиа; 2008. С. 290-331 [Nasonov EL, Karateev DE, Balabanova RM. Rheumatoid arthritis. In: Nasonov EL, Nasonova VA, editors. Revmatologiya. Natsional'noe rukovodstvo [Rheumatology. National guidelines]. Moscow: GEOTAR Media; 2008, P. 290-331].McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. New Engl Med. 2012;365:2205-19. doi: 10.1056/NEJMra1004965McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. New Engl Med. 2012;365:2205-19. doi: 10.1056/NEJMra1004965Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016. doi: 10.1016/S)140-6736(16)30173-7Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016. doi: 10.1016/S)140-6736(16)30173-7Насонов ЕЛ, редактор. Генно-инженерные биологические препараты в лечении ревматоидного артрита. Москва: ИМАПРЕСС; 2013 [Nasonov EL, editor. Genno-inzhenernye biologicheskie preparaty v lechenii revmatoidnogo artrita [Genetically engineered biological agents in the treatment of rheumatoid arthritis]. Moscow: IMA-PRESS; 2013].Насонов ЕЛ, редактор. Генно-инженерные биологические препараты в лечении ревматоидного артрита. Москва: ИМАПРЕСС; 2013 [Nasonov EL, editor. Genno-inzhenernye biologicheskie preparaty v lechenii revmatoidnogo artrita [Genetically engineered biological agents in the treatment of rheumatoid arthritis]. Moscow: IMA-PRESS; 2013].McInnes IB, Buckley CD, Isaaacs JD. Cytokines in theumatoid arthritis – shaping the immunological landscape. Nat Rev Rheumatol. 2016;12:63-8. doi: 10.1038/nrrheum.2015.171McInnes IB, Buckley CD, Isaaacs JD. Cytokines in theumatoid arthritis – shaping the immunological landscape. Nat Rev Rheumatol. 2016;12:63-8. doi: 10.1038/nrrheum.2015.171Sokka T, Pincus T. Rheumatoid arthritis: strategy more important than agent. Lancet. 2009;374:430-2. doi: 10.1016/S0140-6736(09)61432-XSokka T, Pincus T. Rheumatoid arthritis: strategy more important than agent. Lancet. 2009;374:430-2. doi: 10.1016/S0140-6736(09)61432-XPincus T, Kathryn A, Gibson MD, Castrejon I. Update on methotrexate as the anchor drug for rheumatoid arthritis. Bull Hosp Joint Dis. 2013;71(Suppl. 1):S9-19.Pincus T, Kathryn A, Gibson MD, Castrejon I. Update on methotrexate as the anchor drug for rheumatoid arthritis. Bull Hosp Joint Dis. 2013;71(Suppl. 1):S9-19.Smolen JS, Aletaha D, Bijsma JWJ, et al. For the T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631-7. doi: 10.1136/ard.2009.123919Smolen JS, Aletaha D, Bijsma JWJ, et al. For the T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631-7. doi: 10.1136/ard.2009.123919Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update the recommendations of an international task force. Ann Rheum Dis. 2016;75:305. doi: 10.1136/annrheumdis-2015-207524Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update the recommendations of an international task force. Ann Rheum Dis. 2016;75:305. doi: 10.1136/annrheumdis-2015-207524Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69:964-75. doi: 10.1136/ard.2009.126532Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69:964-75. doi: 10.1136/ard.2009.126532Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73:492-509. doi: 10.1136/annrheumdis-2013-204573Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73:492-509. doi: 10.1136/annrheumdis-2013-204573Насонов ЕЛ, Каратеев ДЕ, Чичасова НВ. Рекомендации EULAR по лечению ревматоидного артрита – 2013: общая характеристика и дискуссионные проблемы. Научнопрактическая ревматология. 2013;51(6):609-22 [Nasonov EL, Karateev DE, Chichasova NV. EULAR recommendations for the treatment of rheumatoid arthritis – 2013: General characteristics and disputable problems. Nauchno-Prakticheskaya Revmatologiya= Rheumatology Science and Practice. 2013;51(6):609-22 (In Russ.)]. doi: 10.14412/1995-4484-2013-609-22Насонов ЕЛ, Каратеев ДЕ, Чичасова НВ. Рекомендации EULAR по лечению ревматоидного артрита – 2013: общая характеристика и дискуссионные проблемы. Научнопрактическая ревматология. 2013;51(6):609-22 [Nasonov EL, Karateev DE, Chichasova NV. EULAR recommendations for the treatment of rheumatoid arthritis – 2013: General characteristics and disputable problems. Nauchno-Prakticheskaya Revmatologiya= Rheumatology Science and Practice. 2013;51(6):609-22 (In Russ.)]. doi: 10.14412/1995-4484-2013-609-22Насонов ЕЛ, Каратеев ДЕ, Чичасова НВ. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013): место метотрексата. Научно-практическая ревматология. 2014;52(1):8-26 [Nasonov EL, Karateev DE, Chichasova NV. New recommendations for the management of rheumatoid arthritis (EULAR, 2013): The role of methotrexate. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2014;52(1):8-26 (In Russ.)]. doi: 10.14412/1995-4484-2014-8-26Насонов ЕЛ, Каратеев ДЕ, Чичасова НВ. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013): место метотрексата. Научно-практическая ревматология. 2014;52(1):8-26 [Nasonov EL, Karateev DE, Chichasova NV. New recommendations for the management of rheumatoid arthritis (EULAR, 2013): The role of methotrexate. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2014;52(1):8-26 (In Russ.)]. doi: 10.14412/1995-4484-2014-8-26Насонов ЕЛ. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013) – место глюкокортикоидов. Научно-практическая ревматология. 2015;53(3):238-50 [Nasonov EL. New guidelines for the management of rheumatoid arthritis (EULAR, 2013): The place of glucocorticoids. Nauchno-Prakticheskaya Revmatologiya =Rheumatology Science and Practice. 2015;53(3):238-50 (In Russ.)]. doi: 10.14412/1995-4484-2015-238-250Насонов ЕЛ. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013) – место глюкокортикоидов. Научно-практическая ревматология. 2015;53(3):238-50 [Nasonov EL. New guidelines for the management of rheumatoid arthritis (EULAR, 2013): The place of glucocorticoids. 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The authors declare that there are no conflicts of interest present.