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Zhuravleva Nadezhda V., Karzakova Louise M., Lutkova Tatyana S., Kudryashov Sergey I., Arhipova Anastasia V., Petrova Ekaterina S., Markelova Ludmila L.
Difficulties in Selecting Therapy in a Patient with Seronegative Rheumatoid Arthritis
Keywords: rheumatoid arthritis, genetically engineered biological therapy, methotrexate
The article presents a clinical case of seronegative rheumatoid arthritis in a woman of childbearing age. The described case demonstrates the difficulties in selecting therapy for the treatment of rheumatoid arthritis, the principles of correcting the treatment pattern when rheumatoid arthritis is combined with pregnancy. The issues of overcoming the inefficiency of treatment and selecting different treatment patterns are discussed. Genetically engineered biological drugs must be prescribed according to the algorithm of the Russian Rheumatologists Association simultaneously with disease-modifying anti-rheumatic drugs. These recommendations were adhered in the treatment of the patient. The algorithm for managing patients with rheumatoid arthritis also indicates that in case of inefficiency of a genetically engineered biological drug, it is necessary to cancel it and to administer a drug with a different mode of action. In the presented clinical case, we describe these drug selection events in detail. During the treatment period, four drugs from the group of genetically engineered biological drugs were replaced due to their inefficiency. Repeated correction of treatment patterns, an interdisciplinary approach, and equal responsibility of the rheumatologist and the patient herself for the result of treatment contributed to achieving the goal of treatment – reduction in the activity of rheumatoid arthritis, reduction of DAS28 index to 3,1 points. The considered clinical case shows that in the treatment of rheumatoid arthritis, it may be necessary to repeatedly correct the treatment pattern using genetically engineered biological drugs against the background of baseline therapy to achieve remission or low disease activity.
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About authors
- Zhuravleva Nadezhda V.
- Candidate of Medical Sciences, Associate Professor, Department of Internal Medicine , Chuvash State University, Russia, Cheboksary (zhuravlevanv@mail.ru; ORCID: https://orcid.org/0000-0001-6470-7724)
- Karzakova Luiza M.
- Doctor of Medical Sciences, Professor, Head of Internal Diseases Department, Chuvash State University, Russia, Cheboksary (luizak58@mail.ru; ORCID: https://orcid.org/0000-0002-5899-6352)
- Lutkova Tatyana S.
- Candidate of Medical Sciences, Associate Professor of Internal Diseases Department, Chuvash State University, Russia, Cheboksary (lts21@mail.ru; ORCID: https://orcid.org/0000-0003-2368-5084)
- Kudryashov Sergei I.
- Candidate of Medical Sciences, Associate Professor, Department of Internal Diseases, Chuvash State University, Russia, Cheboksary (medicpro21@mail.ru; ORCID: https://orcid.org/0000-0003-2277-9425)
- Arkhipova Anastasia V.
- Rheumatologist, Republican Clinical Hospital, Russia, Cheboksary (nastya_arh83@mail.ru; ORCID: https://orcid.org/0000-0002-0553-3135)
- Petrova Ekaterina S.
- 6th Year Student, Medicine Faculty, Chuvash State University, Russia, Cheboksary (Ekaterina1996.96@mail.ru; )
- Markelova Ludmila L.
- 5th Year Student, Medicine Faculty, Chuvash State University, Russia, Cheboksary (markelovtatyana@yandex.ru; )
Article link
Zhuravleva Nadezhda V., Karzakova Louise M., Lutkova Tatyana S., Kudryashov Sergey I., Arhipova Anastasia V., Petrova Ekaterina S., Markelova Ludmila L. Difficulties in Selecting Therapy in a Patient with Seronegative Rheumatoid Arthritis [Electronic resource] // Acta medica Eurasica. – 2020. – №1. P. 44-51. – URL: https://acta-medica-eurasica.ru/en/single/2020/1/6/.