Sh.Ph. ERDES ¹, T.V. DUBININA¹, S.А. LAPSHINA², L.I. MYASOUTOVA², D.I. ABDULGANIYEVA²

¹Nasonova Research Institute of Rheumatology RAMS, 34A Kashirskoye highway, Moscow, Russian Federation, 115522

²Kazan State Medical University, Butlerova St., 49, Kazan, Russian Federation, 420012

Erdes Sh.Ph. — D. Med. Sc., Professor, Deputy Director for Science, tel. (499)614-44-86, e-mail: omsi@irramn.ru

Dubinina T.V. — Cand. Med. Sc., Senior Researcher of laboratory of spondylarthritis, tel. (499) 614-44-76, e-mail: omsi@irramn.ru

Lapshina S.A. — Cand. Med. Sc., Associate Professor of the Department of Hospital Therapy,

tel. (843) 237-34-83, e-mail: svetlanalapshina@mail.ru.

Myasoutova L.I. — Assistant of the Department of Hospital Therapy, tel. (843) 237-34-83, e-mail: myasoutova74@mail.ru

Abdulganieva D.I. — D. Med. Sc., Professor, Head of the Department of Hospital Therapy with the course of Endocrinology, tel. (843) 237-34-83, e-mail: diana_s@mail.ru

In the treatment of ankylosing spondylitis (AS) the question about personalized approach to a choice of tactics of treatment based on the variety of clinical symptoms, their severity, the presence of prognostic factors, comorbid conditions, preferences and expectations of the patient is increasingly raised. The primary goal of treatment is to maximize the long preservation of the quality of life of the patient. The mainstay of therapy is prolonged and continuous administration of non-steroidal anti-inflammatory drugs (NSAIDs), which are the first-line drugs for the treatment of AS. At the same time, the use of traditional basic drugs (methotrexate, leflunomide, sulfasalazine) is limited and their effectiveness against axial manifestations of AS is comparable to placebo. The article presents the indications and the effectiveness of anti TNF inhibitors.
Key words: ankylosing spondylitis, drug therapy, nonsteroidal anti-inflammatory drugs, anti TNF inhibitors.

REFERENCES

1. Erdes Sh.F. Basic principles of treatment of ankylosing spondylitis (ankylosing spondylitis). Nauchno-prakticheskaya revmatologiya, 2013, 51(6), 686-95 (in Russ.). DOI:http://dx.doi.org/10.14412/1995-4484-2013-686-95.
2. Smolen J.S., Braun J., Dougados M. et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target. recommendations of an international task force. Ann Rheum Dis, 2014, vol. 73(1), rr. 6-16. DOI:10.1136/annrheumdis-2013-203419.
3. Braun J., van den Berg R., Baraliakos X., Boehm H., Burgos-Vargas R. et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis, 2011, vol. 70(6), rr. 896-904. Doi:10.1136/ard.2011.151027.
4. Sidiropoulos P.I., Hatemi G.,  Song I.-H. et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists. Rheumatology, 2008, vol. 47, rr. 355-361. Doi:10.1093/rheumatology/kem348.
5. AmoR B., Dougados M., Mijiyawa M. Critères de classification des spondylarthro pathies. Rev Rhum, 1990, vol. 57, rr. 85-9.
6. Rudwaleit M., Landewe R., van der Heijde D. et al. SpondyloArthritis international Society (ASAS) Classification Criteria for Axial Spondyloarthritis (Part II): Validation and Final Selection. Ann Rheum Dis, 2009, vol. 68(6), rr. 777-83.
7. Dougados M., Simon P., Braun J., Burgos-Vargas R. et al. ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis, 2011, vol. 70(2), rr. 249-51. Doi:10.1136/ard.2010.133488.
8. Karateev A.E., Erdes Sh.F. The use of NSAIDs in ankylosing spondylitis: long and hard. Terapevticheskiy arkhiv, 2014, no. 11, pp. 123-27 (in Russ.).
9. Bochkova A.G. Osobennosti primeneniya nesteroidnykh protivovospalitel’nykh preparatov pri spondiloartritakh. Consilium Medicum, 2010, vol. 12(9), rr. 13-18 (in Russ.).
10. Poddubnyy D., Rudwaleit M., Haibel H., Listing J., Märker-Hermann E., Zeidler H., Braun J., Sieper J. Effect of non-steroidal anti-inflammatory drugs on radiographic progression in patients with axial spondyloartrhitis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis, 2012, vol. 71(10), rr. 1616-22. Doi:10.1136/annrheumdis-2011-201252.
11. Boersma J. Retardation of ossification of the lumbar vertebral column in ankylosing spondylitis by means of phenylbutazone. Scand J Rheumatol, 1976, vol. 5(1), rr. 60-4.
12. Wanders A., Heijde Dv., Landewé R., Béhier J.M. et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum, 2005, vol. 52(6), rr. 1756-65. PMID: 15934081.
13. Haroon N., Shen H., Carty A. et al. Continuance of non-steroidal anti-inflammatory drugs may reduce radiographic progression in ankylosing spondylitis patients on biological therapy. Arthritis Rheum, 2011, vol. 63, 1303 r.
14. Jarrett S.J., Sivera F., Cawkwell L.S. et al. MRI and clinical findings in patients with ankylosing spondylitis eligible for anti-tumour necrosis factor therapy after a short cource of etoricoxib. Ann Rheum Dis, 2009, vol. 68(9), rr. 1466-9.
15. Tyukhova E.Yu., Bochkova A.G., Levshakova A.V., Rumyantseva O.A., Erdes Sh.F., Marko S.A., Smirnov A.V. Comparative evaluation of the effect of inhibitors of tumor necrosis factor α, and nonsteroidal antiinflammatory drugs on the inflammatory changes in the spine according to magnetic resonance imaging in patients with ankylosing spondylitis. Nauchno-prakticheskaya revmatologiya, 2012, no. 3, rr. 49-55 (in Russ.).
16. Revmatologiya: Klinicheskie rekomendatsii, pod. red. akad. RAMN E.L. Nasonova. 2-e izdanie, ispravlennoe i dopolnennoe [Rheumatology: Clinical recommendations. Under. Ed. Acad. E.L. Nasonov. 2nd edition, revised and enlarged]. Moscow: GEOTAR-Media.
17. Karateev A.E., Alekseeva L.I., Filatova E.G., Moroz E.V., Tyurin V.P., Nasonov E.L. Obezbolivayushchie preparaty v terapevticheskoy praktike [Analgesics in therapeutic practice]. Moscow: IMA-PRESS, 2013. 136 p. ISBN 978-5-904356-19-4.
18. Song I.H., Poddubnyy D.A., Rudwaleit M., Sieper J. Benefits and Risks of Ankylosing Spondylitis Treatment With Nonsteroidal Antiinflammatory Drugs. Arthritis & rheumatism, 2008, vol. 58(4), rr. 929-938. DOI 10.1002/art.23275.
19. Bochkova A.G. The role of glucocorticoids in the treatment of spondyloarthritis. Sovremennaya revmatologiya, 2011, no. 1, pp. 76-78 (in Russ.).
20. Akkoc N., van der Linden S., Khan M.A. Ankylosing spondylitis and symptom-modifying vs disease-modifying therapy. Best Pract Res Clin Rheumatol, 2006, Jun, vol. 20(3), rr. 539-57. PMID: 16777581.
21. Roychowdhury B., Bintley-Bagot S., Bulgen D.Y. et al. Is methotrexate effective in ankylosing spondylitis? Rheumatology (Oxford), 2002, vol. 41, rr. 1330-1332.
22. Sampaio-Barros P.D., Costallat L.T., Bertolo M.B. et al. Methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol, 2000, vol. 29(3), rr. 160-2.
23. Biasi D., Carletto A., Caramaschi P., Pacor M.L. et al. Efficacy of methotrexate in the treatment of ankylosing spondylitis: a three-year open study. Clin Rheumatol, 2000, vol. 19(2), rr. 114-7.
24. Braun J., Pham T., Sieper J., Davis J., van der Linden S., Dougados M., van der Heijde D. ASAS Working Group. International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis. Ann Rheum Dis, 2003, Sep, vol. 62(9), rr. 817-24. Review. PMID: 12922952.
25. Spadaro A., Punzi L., Marchesoni A., Lubrano E. et al. Switching from infliximab or etanercept to adalimumab in resistant or intolerant patients with spondyloarthritis: a 4-year study. Rheumatology (Oxford), 2010, Jun, vol. 49(6), rr. 1107-11. 20223813.1.
26. Erdes Sh.F., Bochkova A.G., Dubinina T.V., Rumyantseva O.A., Smirnov A.V. Early diagnosis of ankylosing spondylitis. Nauchno-prakticheskaya revmatologiya, 2013, no. 4 (51), pp. 365-8 (in Russ.).
27. Baraliakos X., Listing J., Fritz C., Haibel H. et al. Persistent clinical efficacy and safety of infliximab in ankylosing spondylitis after 8 years-early clinical response predicts long-term outcome. Rheumatology (Oxford), 2011, vol. 50, rr. 1690-1699.
28. Rumyantseva O.A., Bochkova A.G., Kuzikyants K.Kh., Levshakova A.V., Erdes Sh.F., Nasonov E.L. Experience of prolonged treatment with infliximab in patients with ankylosing spondylitis. Nauchno-prakticheskaya revmatologiya, 2010, no. 6, pp. 16-22 (in Russ.).
29. Burmester G.R., Panaccione R., Gordon K.B. et al. Adalimumab: long-term safety in 23,458 patients from global clinical trials in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn’s disease. Ann Rheum Dis, 2013, vol. 72, rr. 517-24.
30. Keystone E.C. Does anti-tumor necrosis factor-α therapy affect risk of serious infection and cancer in patients with rheumatoid arthritis? A review of long-term data. J Rheumatol, 2011, vol. 38, rr. 1552-62.