THE INFLUENCE OF COMORBIDITY AND EXTRA-ARTICULAR MANIFESTATIONS OF RHEUMATOID ARTHRITIS ON THE EFFICACY AND TOLERABILITY OF SYNTHETIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS
Summary. Summary. To study the influence of comorbidity and extra-articular manifestations of rheumatoid arthritis (RA) on the efficacy and tolerability of disease modifying antirheumatic drugs (DMARDs) 402 RA patients were examined, 182 of them within 2 years received prescribed DMARDs continuously. Concomitant pathology was observed in 58.7% of patients, mainly cardiovascular (27.1% of cases); 25% of patients had multiple comorbid conditions. The most frequent comorbidities were arterial hypertension (AH) and thyroid disease. Extra-articular manifestations of RA in 175 (43.5%) patients were observed. A group of patients with comorbid conditions and systemic manifestations of RA simultaneously differed from other by older age, a large number of seropositive patients and higher clinical and laboratory RA activity (according to DAS28). After 2 years of DMARDs therapy in patients with concomitant diseases clinical response (by ΔDAS28) was significantly lower compared with patients without comorbidity, but there wasn’t significant differences in radiographic dynamics. DMARDs effectiveness didn’t depend on the presence of AH, but in patients with thyroid disorders clinical response was significantly worse (by 34.0%) compared to patients without comorbid pathologies. Clinical response to DMARDs didn’t depend on the presence of systemic manifestations of RA, but the rate of radiographic progression was significantly higher (by 45%) in patients with vs without systemic RA manifestations. The presence of comorbidity associated with a higher incidence of side effects of DMARDs, particularly of the digestive system (2 times higher). Tolerability of treatment in patients with and without comorbidities was not significantly dependent on DMARDs prescribed.
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