Rekalov D. Developing criteria forearly diagnosis,prognosis, studyof individualtreatment programsthatmodifythe course ofrheumatoidarthritis.

The thesis presents the theoretical generalization and a new resolve scientific problems - improving the diagnosis of early rheumatoid arthritis (eRA) based on the proposed new markers, prediction of functional failure of the musculoskeletal system and inefficiency of the standard regimen, and program design individualized pharmacotherapy of patients with the inclusion of biological agents - inhibitors of tumor necrosis factor-alfa (TNF-alfa) on the basis of comprehensive clinical and laboratory-instrumental dynamic evaluation of patients. First set of clinical and laboratory and instrumental predictors and created mathematical models of adverse current eRA based on the proposed criteria and indications for an individual appointment early aggressive pharmacotherapy. Demonstrated the diagnostic value of determining the ACPA level as an independent diagnostic marker of RA. Found that the simultaneous increase in eRA YKL-40, СOMP, CTP-I, OPG, VEGF, CTP-II is an integral indicator of the severity of inflammatory-destructive changes of tissues affected joints, which reflects the activity of the disease. Dynamics of VEGF in synovial fluid of patients with eRA recommended as a potential predictor of local joint destruction and response to pharmacotherapy. First identified predictors of progression of systemic changes CTC - osteopenia and osteoporosis in patients with eRA, namely the number of affected large joints alfa 3 debut in disease activity index DAS28, and the initial level ACPA, and features of bone loss in different areas of skeleton. Found that the progression of functional failure of the joints depends on the duration of disease, HAQ alfa 1 in eRA, a high titer RF positivity for ACPA. Lesions of tendons of flexors and extensors of fingers in RA prior damage to other tissues of the musculoskeletal system, and the severity of these changes is a predictor of the need to use individual treatment programs based on biological agents - inhibitors of TNF-?. It is shown that female gender, duration of symptoms of RA, high disease activity indices off by DAS28 and functional status by HAQ, smoking - indicators that determine the lack of efficacy of methotrexate as the main product of RA basic therapy. We construct our mathematical model of regression dependence of functional failure of the joints, and severity chondro-erosive and osteopenic processes depending on different sets of variables extending the range of possible pathogenetic predictors that determine the peculiarities of the eRA.