Number№82 (4) 2020


Kulinich A.V., Рекалов Д.Г.

Summary. Relevance. Rheumatoid arthritis (RA) is an autoimmune rheumatic disease of unknown etio­logy, which is characterized by chronic erosive arthritis (synovitis) and systemic damage of internal organs, including the kidney. There are few data regarding the renoprotective properties of basic drugs, and the results are ambiguous. Objective: to study the nephroprotective potential of basic therapy drugs in patients with early rheumatoid arthritis (eRA). Material and research methods. A cohort of 35 patients with eRA was randomly formed and divided into 2 subgroups: 1-st subgroup received methotrexate (23 people, 7.5–10 mg/week) and 2-nd subgroup — tocilizumab and methotrexate (12 people). The results of the study. Against the background of the ongoing tocilizumab therapy, a positive clinical effect was observed in all patients. It was manifested by a pronounced reduction of the articular syndrome. Patients noted a decrease in the time of morning stiffness, the intensity of the pain syndrome, a decrease in the number of painful and swollen joints, and an increase in the range of motion in them (which was also confirmed by an objective examination). The DAS-28 disease activity index decreased unidirectionally with both methotrexate and tocilizumab treatment patients with eRA. The study of parameters characterizing the intensity of the pain syndrome (according to visual analogue scale (VAS)) and functional insufficiency (according to the HAQ questionnaire) in the examined patients with eRA against the background of various treatment protocols indicates good positive dynamics in both cohorts of patients with a statistically significant predominance of the efficacy of tocilizumab compared with the group methotrexate. Also, the treatment significantly statistically (p<0.05) increased the functional renal reserve of patients — by 45.11 and 175.76% in the methotrexate and tocilizumab groups, respectively, which indicates a significant improvement in the renal filtration reserve during treatment of this joint pathology. Preservation of functional renal reserve is observed after 3 months of the treatment of patients with eRA by tocilizumab is 78.03% higher than in the first subgroup receiving methotrexate. Conclusions. The therapy with tocilizumab, in addition to a reliable clinical effect, was characterized by high nephroprotective activity. Thus, the decrease in urinary microtein excretion were 84.80% and 70.83% for microalbumin and β2-microglubulin, respectively (p<0.05). At the same time, there was a statistically significant increase in the reserve filtration function of the kidneys (increase in the filtration renal reserve was 175.76%, p<0.01) without a decrease in the initial level of glomerular filtration according to the clearance of endogenous creatinine.

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