Mykytenko G. Differentiated approach to prescription of DMARD therapy for patients with very early, early and late rheumatoid arthritis

The problem of increase of efficacy and safety of methotrexate (MTX), leflunomide (LF), sulfasalazine (SS) and combined basic therapy (CBT) application in very early, early and late rheumatoid arthritis (RA) treatment has been solved by the author of the dissertation. The connection between presence, titre of antibodies against cyclic citrullinated peptides (anti-CCP antibodies) and clinical, laboratory characteristics of RA, response to treatment was assessed. It is important to determine anti-CCP antibodies even in RF(+) patients. Presence and titre of anti-CCP antibodies is associated with higher disease activity and worse response to treatment. SS can be prescribed to patients with low degree of activity; to patients with higher degree of activity but RF(-), anti-CCP(-) RA, without extra-articular manifestations and erosive RA. LF is better for early (<= 24 mth) and late (> 24 mth) anti-CCP(+) RA, with high CRP level. MTX as effective disease-modifying antirheumatic drug (in dose >=15 mg/week) can be prescribed for all patients except patients with early and late anti-CCP(+) RA. In case of uneffectiveness of MTX or LF for patients with moderate or high degree of activity CBT must be prescribed: for very early anti-CCP(+) RA with high CRP level; for early anti-CCP(+) RA despite of CRP level; for non-erosive late RA