Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya3356210.26442/00403660.2019.05.000259Editorial articleПередовая статьяReview ArticleRheumatoid arthritis: achievements and unresolved issuesРевматоидный артрит: достижения и нерешенные проблемыNasonovE LНасоновЕвгений Львович

акад. РАН, д.м.н., проф., научный руководитель ФГБНУ «НИИР им. В.А. Насоновой»

nasonov@irramn.ruLilaA MЛилаАлександр Михайлович

д.м.н., проф., директор ФГБНУ «НИИР им. В.А. Насоновой»

V.A. Nasonova Scientific and Research Institute of RheumatologyФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»I.M. Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation (Sechenov University)ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)15052019915VOL 91, NO5 (2019)ТОМ 91, №5 (2019)4716042020Copyright ©; 2019, Consilium MedicumCopyright ©; 2019, ООО "Консилиум Медикум"2019Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/33562

Success in a treatment of rheumatoid arthritis (RA), associated with a development of new medications and improving treatment strategies, allows to achieve remission in many patients. Despite this a lot of theoretical and clinical issues remain, including a definition of the term "remission", its characteristics and types as well as approaches to optimal tactics of "symptomatic" and "pathogenetic" drug therapy at different stages of the disease. Use of a such tactics will allow to induce quickly a state of remission and maintain it for a long term. Further research is needed which should be directed to investigation of a heterogeneity of RA pathogenetic mechanisms and to elaboration of approaches to its early diagnosis as well as to improving methods for monitoring a disease activity, biomarkers of efficacy and resistance to therapy, and finally, to developing of a differentiated therapy, including a search for new “therapeutic” targets.

Несмотря на достигнутые успехи в лечении ревматоидного артрита (РА), связанные с разработкой новых лекарственных препаратов и совершенствованием стратегии лечения, позволяющих достигнуть ремиссии у многих пациентов, остается много теоретических и клинических проблем, касающихся как определения понятия «ремиссия», ее характеристики и типов, так и подходов к оптимальной тактике «симптоматической» и «патогенетической» лекарственной терапии на разных стадиях болезни, применение которой позволит быстро индуцировать состояние ремиссии и поддерживать ее в долгосрочной перспективе. Необходимы дальнейшие исследования, направленные на изучение природы гетерогенности патогенетических механизмов РА, подходов к ранней диагностике, совершенствование методов мониторинга активности заболевания, биомаркеров эффективности и резистентности к терапии и, наконец, разработки дифференцированной терапии, в том числе связанной с поиском новых «терапевтических» мишеней.

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