rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2023-435-449rsp-3398Research ArticleМЕЖДУНАРОДНЫЕ И РОССИЙСКИЕ РЕКОМЕНДАЦИИ ПО ЛЕЧЕНИЮ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЙINTERNATIONAL AND RUSSIAN GUIDELINES FOR THE TREATMENT OF RHEUMATIC DISEASESПрименение метотрексата при ревматоидном артрите. Рекомендации Общероссийской общественной организации «Ассоциация ревматологов России»The use of methotrexate in rheumatoid arthritis. Recommendations of the All-Russian public organization “Association of Rheumatologists of Russia”https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522,  Москва, Каширское шоссе, 34а

119991,  Москва, ул. Трубецкая, 8, стр. 2

115522,  Moscow, Kashirskoye Highway, 34A

119991,  Moscow, Trubetskaya str., 8, building 2

https://orcid.org/0000-0001-5382-6357АмирджановаВ. Н.AmirjanovaV. N.

115522,  Москва, Каширское шоссе, 34а

115522,  Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-8665-7980ОлюнинЮ. А.OlyuninY. A.

115522,  Москва, Каширское шоссе, 34а

115522,  Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5394-883XМуравьевЮ. В.MuravyevY. V.

115522,  Москва, Каширское шоссе, 34а

115522,  Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7847-1679БарановА. А.BaranovA. A.

150000,  Ярославль, ул. Революционная, 5

150000, Yaroslavl, Revolyutsionnaya str., 5

https://orcid.org/0000-0001-8529-4105ЗоноваЕ. В.ZonovaE. V.

630091, Новосибирск, Красный просп., 52

630091, Novosibirsk, Krasniy avenue, 52

https://orcid.org/0000-0002-2365-5734ОттеваЭ. Н.OttevaE. N.

680009,  Хабаровск, ул. Краснодарская, 9

680009, Khabarovsk, Krasnodarskaya str., 9

https://orcid.org/0000-0002-3235-1425ЗагребневаА. И.ZagrebnevaA. I.

117997,  Москва, ул. Островитянова, 1

123182, Москва, Пехотная ул., 3

117997,  Moscow, Ostrovitianova str., 1

123182,  Moscow, Pekhotnaya str., 3

 

https://orcid.org/0000-0001-7069-2725АбдулганиеваД. И.AbdulganievaD. I.

420012,  Казань, ул. Бутлерова, 49

420012,  Kazan, Butlerova str., 49

ПчельниковаП. И.PchelnikovaP. I.

115516,  Москва, ул. Промышленная, 11, стр. 3, ком. 18

115516,  Moscow, Promyshlennaya str, 11, building 3, room 18

ФГБНУ «Научно- исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияV.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)Russian FederationФГБНУ «Научно- исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава РоссииРоссияYaroslavl State Medical UniversityRussian FederationФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава РоссииРоссияNovosibirsk State Medical UniversityRussian FederationКГБУЗ «Краевая клиническая больница имени профессора С.И. Сергеева» Министерства здравоохранения Хабаровского краяРоссияProfessor S.I. Sergeev Regional Clinical HospitalRussian Federation6ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России; ГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения города Москвы»РоссияN.I. Pirogov Russian National Research Medical University; City Clinical Hospital No. 52 of Moscow Healthcare DepartmentRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical UniversityRussian FederationОООИ «Российская ревматологическая ассоциация «Надежда»РоссияRussian Association of Rheumatology “Nadezhda”Russian Federation202331082023614435449Copyright © Насонов Е.Л., Амирджанова В.Н., Олюнин Ю.А., Муравьев Ю.В., Баранов А.А., Зонова Е.В., Оттева Э.Н., Загребнева А.И., Абдулганиева Д.И., Пчельникова П.И., 20232023Насонов Е.Л., Амирджанова В.Н., Олюнин Ю.А., Муравьев Ю.В., Баранов А.А., Зонова Е.В., Оттева Э.Н., Загребнева А.И., Абдулганиева Д.И., Пчельникова П.И.Nasonov E.L., Amirjanova V.N., Olyunin Y.A., Muravyev Y.V., Baranov A.A., Zonova E.V., Otteva E.N., Zagrebneva A.I., Abdulganieva D.I., Pchelnikova P.I.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/3398

Ревматоидный артрит (РА) – наиболее частое иммуновоспалительное (аутоиммунное) ревматическое заболевание, характеризующееся хроническим эрозивным артритом и системным поражением внутренних органов. Данные, полученные в процессе фундаментальных исследований, касающихся расшифровки механизмов действия метотрексата (МТ), и материалы многочисленных рандомизированных плацебо-контролируемых исследований, наблюдательных исследований и национальных регистров укрепили позиции МТ в качестве «золотого стандарта» фармакотерапии РА и ключевого компонента стратегии «Лечение до достижения цели». Это послужило основанием для разработки новых рекомендаций Ассоциации ревматологов России (АРР), касающихся применения МТ при РА, согласно которым МТ рассматривается как препарат «выбора» для индукции и поддержания ремиссии у пациентов с ранним и развернутым РА, в том числе нуждающихся в проведении комбинированной терапии МТ с глюкокортикоидами, стандартными базисными противовоспалительными препаратами (БПВП), генно-инженерными биологическими препаратами и таргетными синтетическими БПВП. Особое внимание уделяется безопасности терапии МТ и влиянию МТ на коморбидную патологию, связанную с кардиоваскулярными осложнениями и интерстициальным заболеванием легких. Внедрение рекомендаций АРР в клиническую практику позволит снизить риск инвалидности и улучшить жизненный прогноз у пациентов с РА.

Rheumatoid arthritis (RA) is the most frequent immunoinflammatory (autoimmune) rheumatic disease characterized by chronic erosive arthritis and systemic damage to internal organs. The data obtained in the course of basic research on deciphering the mechanisms of action of methotrexate (MT) and the materials of numerous randomized placebocontrolled trials, observational studies and national registries have strengthened the position of MT as the “gold standard” of RA pharmacotherapy and a key component of the “Treatment to Target” strategy. This was the basis for the development of new recommendations of the Association of Rheumatologists of Russia (ARR) concerning the use of MT in RA, according to which MT is considered as the drug of “choice” for induction and maintenance of remission in patients with early and advanced RA, including those who need combination therapy of MT with glucocorticoids, standard Disease-Modifying Antirheumatic Drugs (DMARDs), biologics and targeted synthetic DMARDs. Special attention is paid to the safety of MT therapy and the impact of MT on comorbid pathology associated with cardiovascular complications and interstitial lung disease. Implementation of the ARR recommendations into clinical practice will reduce the risk of disability and improve life prognosis in patients with RA.

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The authors declare that there are no conflicts of interest present.