Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance
The present study considers a care of a 42-year old female patient with a severe variant of rheumatoid arthritis and extra-articular manifestations. The debut clinical symptoms included polyarthritis, fever, and anemia. On selection of a basic therapy, intolerance (leucopenia, flu-like syndrome) and...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
2016-12-01
|
| Series: | Сеченовский вестник |
| Subjects: | |
| Online Access: | https://www.sechenovmedj.com/jour/article/view/573 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849403539776864256 |
|---|---|
| author | D. A. Kusevich G. R. Imametdinova N. V. Chichasova E. L. Nasonov |
| author_facet | D. A. Kusevich G. R. Imametdinova N. V. Chichasova E. L. Nasonov |
| author_sort | D. A. Kusevich |
| collection | DOAJ |
| description | The present study considers a care of a 42-year old female patient with a severe variant of rheumatoid arthritis and extra-articular manifestations. The debut clinical symptoms included polyarthritis, fever, and anemia. On selection of a basic therapy, intolerance (leucopenia, flu-like syndrome) and inefficiency of treatment regimen have been revealed. Administration of a genetically engineered biological drug resulted in the development of tuberculosis and the patient required a long break in the biotherapy for a specific treatment course. The use of anti-TNF agents is associated with an increased risk to tuberculosis and anti-TNF agents are stopped when active tuberculosis develops. However, discontinuation of treatment results in a flare of the underlying disease. The rituximab therapy was initiated because the clinicolaboratory activity was high. Due to the strategy “Treat to Target”, the patient reached improvement by classification criteria and clinical and laboratory remission. The use of high doses of glucocorticoids during the patient’s planning pregnancy led to the development of secondary osteoporosis with spontaneous fractures of pelvic bones and ribs, expressed progression of erosive process, deformations of small and large joints. Specific features of the course of disease with formation of a severe progressing form of rheumatoid arthritis and the conducted treatment were considered from the point of view of difficulty in the selection of therapy when rheumatologists had a limited arsenal of drugs. The risk of re-onset of tuberculosis infection mandates careful follow-up. |
| format | Article |
| id | doaj-art-68fb35de04ea404a9e555eaad6e6bffb |
| institution | Kabale University |
| issn | 2218-7332 2658-3348 |
| language | Russian |
| publishDate | 2016-12-01 |
| publisher | Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University) |
| record_format | Article |
| series | Сеченовский вестник |
| spelling | doaj-art-68fb35de04ea404a9e555eaad6e6bffb2025-08-20T03:37:16ZrusFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Сеченовский вестник2218-73322658-33482016-12-01045357267Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intoleranceD. A. Kusevich0G. R. Imametdinova1N. V. Chichasova2E. L. Nasonov3I.M. Sechenov First MSMUI.M. Sechenov First MSMUI.M. Sechenov First MSMUI.M. Sechenov First MSMUThe present study considers a care of a 42-year old female patient with a severe variant of rheumatoid arthritis and extra-articular manifestations. The debut clinical symptoms included polyarthritis, fever, and anemia. On selection of a basic therapy, intolerance (leucopenia, flu-like syndrome) and inefficiency of treatment regimen have been revealed. Administration of a genetically engineered biological drug resulted in the development of tuberculosis and the patient required a long break in the biotherapy for a specific treatment course. The use of anti-TNF agents is associated with an increased risk to tuberculosis and anti-TNF agents are stopped when active tuberculosis develops. However, discontinuation of treatment results in a flare of the underlying disease. The rituximab therapy was initiated because the clinicolaboratory activity was high. Due to the strategy “Treat to Target”, the patient reached improvement by classification criteria and clinical and laboratory remission. The use of high doses of glucocorticoids during the patient’s planning pregnancy led to the development of secondary osteoporosis with spontaneous fractures of pelvic bones and ribs, expressed progression of erosive process, deformations of small and large joints. Specific features of the course of disease with formation of a severe progressing form of rheumatoid arthritis and the conducted treatment were considered from the point of view of difficulty in the selection of therapy when rheumatologists had a limited arsenal of drugs. The risk of re-onset of tuberculosis infection mandates careful follow-up.https://www.sechenovmedj.com/jour/article/view/573rheumatoid arthritisgenetic engineering biological agents |
| spellingShingle | D. A. Kusevich G. R. Imametdinova N. V. Chichasova E. L. Nasonov Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance Сеченовский вестник rheumatoid arthritis genetic engineering biological agents |
| title | Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance |
| title_full | Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance |
| title_fullStr | Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance |
| title_full_unstemmed | Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance |
| title_short | Severe rheumatoid arthritis with multiple baseline anti-inflammatory drugs intolerance |
| title_sort | severe rheumatoid arthritis with multiple baseline anti inflammatory drugs intolerance |
| topic | rheumatoid arthritis genetic engineering biological agents |
| url | https://www.sechenovmedj.com/jour/article/view/573 |
| work_keys_str_mv | AT dakusevich severerheumatoidarthritiswithmultiplebaselineantiinflammatorydrugsintolerance AT grimametdinova severerheumatoidarthritiswithmultiplebaselineantiinflammatorydrugsintolerance AT nvchichasova severerheumatoidarthritiswithmultiplebaselineantiinflammatorydrugsintolerance AT elnasonov severerheumatoidarthritiswithmultiplebaselineantiinflammatorydrugsintolerance |