Gnylorybov A. Individual pathogenetic disease-modifying antirheumatic drug therapy and its effectiveness in rheumatoid arthritis patients (clinical & experimental study)

Study object - rheumatoid arthritis (RA) patients and animal model of systemic autoimmune disease. Objective - to improve treatment effectiveness of RA patients by the development and implementation in medical practice of individual pathogenetic disease modifying therapy. Methods - clinical, biochemical, immunological, immune-enzyme analysis, X-ray, instrumental, morphological (morphometry, immunohistochemistry), statistics. Novelty - for the first time the correlation between enzymes activity of nucleotides metabolism and intensity of proliferative-erosive changes in the experimental animal model of RA was identified, significance of disease modifying therapy influence on immunological, neuroimmune data and enzymes activity of nucleotide metabolism was proven clinically and experimentally for the purpose of monitoring of proposed therapy effectiveness. The correlation between pyrimidines and purines metabolism in RA patients and X-ray joint destruction rate and other parameters of disease course (activity, functional insufficiency etc.) was shown. Clinical importance of neuroimmune system mediators for RA course was studied, possibility of application of the developed prognostic disease model for novel optimal treatment technology of rational controlled disease modifying therapy of RA patients was proven. Results - medical technology of prognosis of clinical and structure modifying therapy effectiveness in RA patients was developed, which resulted in improvement of therapy effectiveness by individual pathogenetically grounded disease modifying therapy and differentiated use of "step-up" and "step-down" therapy. It was introduced in practice of V.K.Gusak Institute of Urgent and Recovery Surgery of AMS of Ukraine, Donetsk regional clinical territorial medical association, therapy department of Donetsk national medical university, Kharkiv and Lugansk regional clinical hospitals, and also in teaching practice of Donetsk, Kharkiv Lugansk, Zaporizzhya medical universities. Field of use - treatment and diagnostics process of rheumatology and therapy departments, scientific and teaching process of therapy chairs of medical universities.