How to break through the re-enactment of moderate-severe RA patients, this case "bright"!

Introductionrheumatoid arthritis (RA) is a systemic autoimmunedisease characterized by aggressive arthritis, with a incidence rate of 0.42% in China and about 5 million in the total populationWith the progress of the disease, RA can be accompanied by joint activity disorders and even physical disabilities, resulting in the loss of patients' ability to work, quality of life, to patients, families and society to create a huge financial burdenrais is not yet curableThe international first push to meet the standard treatment, that is, treatment should be as soon as possible through the control of symptoms, delay bone damage, restore joint function and other ways to maximize the quality of life of RA patients, but standard treatment is not easythis issue, we invited The First Central Hospital of Tianjin RheumatologyImmunologyDirector Xu Huiping to share the case, invited Baotou Medical College, the first affiliated hospital of the Department of Rheumatology Immunology Director Wang Yongfu to give a wonderful case review01Cases preemptively look atpatients, Zhou a certain, female, 50 years old, due to repeated multi-joint swelling pain 18 years, in the hospitaldiagnosis"RA", the initial application of herbal medicine, unknown ingredients of Chinese medicine, injection of long-acting corticosteroids and other treatment, joint symptoms repeatedin 2007 began my hospital visit, follow-up treatment after the following:1 has been applied methotrexate (MTX), lefluoromet, Regongtodo polythedum and other traditional improvement of the disease anti-rheumatoid drugs (csDMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs), the efficacy is not good 2 follow-up attempts to use cyclophosphamide and thiopental were treated with obvious adverse reactions, and granulocyte deficiency occurred during the application of thiostonine, and the drug was discontinued 3 the application of recombinant human type II tumor necrosis factor receptor fusion protein for more than 2 months, while the efficacy of csDMARDs with csDMARDs was not obvious 4 infusion of infusion of infusion of infusion of infusion of infusion of infusion of infusion, symptoms significantly improved, during which there was an infusion reaction (facial rash), and then again applied, no rash appeared, the drug more than 1 year, the feeling of decreased efficacy, replacement csDMARDs efficacy no improvement 5 during the above treatment two trips to Shanghai for double ankle, knee sliding membrane resection, the post-operative joint still pain 6 June 30, 2013 due to increased joint symptoms re-admission, check: C reactive protein (CRP) 3.04 mg/L, blood sink (ESR) 58 mm/H, rheumatoid factor (RF) 522 IU/ml, anti-cyclic polypeptide antibodies (ACCP) 250 IU/ml, right joint MRI oede, bone erosion, bone erosion (Figure 1) on June 30, , add Adamum monobifying (Sumera) 40mg/2 weeks, joint csDMARDs: leflunomide 20mg/QD, MTX 10mg/QW, joint symptoms significantly improved regular use of 4 times after the results of CRP 0.848 mg/L, RF 303 IU/ml, ESR 32 mm/H, compared with the previous drug treatment significantly improved the condition , the patient's right knee MRI 7 subsequently discontinued in January, the patient again developed an increase in joint pain, and again added flumit 8 the current condition control is stable, gradually extended the interval of Aadamu monoto-injection, now January-February injection of Adamu smostatin 40 mg, oral leflunomet, MTX 2019.5.9 Review test CRP 0.781 mg/dL, blood sink 21 mm/H, DAS28-CRP 2.59, DAS28-ESR 2.97, close to reaching the condition of relief summary of medical history: 1, the patient's diagnosis RA clear, stubborn disease; 2, disease early missed treatment opportunity; 3, csDMARDs poor efficacy, side effects; 4, previous irregular application of recombinant human type II tumor necrosis cause of sub-receptor fusion protein efficacy is not good; Inflissi monoabone treatment is effective in the early stage, late secondary failure; 5, the replacement of Adamu monoystalysis treatment effective, combined csDMARDs treatment, extended treatment Expert Introduction Xu Huiping Director of Rheumatology Immunology department of Tianjin First Central Hospital, Master of Medicine, graduated from Tianjin Medical University in 1993, focusing on the clinical and teaching work of medical difficulties and rheumatoid immune system diseases, Beijing Concord Hospital students, Tianjin Anti-Aging Society gout and nucleic acid metabolism professional committee member, Tianjin First Central Hospital, medical center, medical center, 02 Case Review anchorthe the best drug how to deal with the RA treatment dilemma? still consider csDMARDs to be the cornerstone of RA treatment and a first-line drug jointly recognized by domestic and foreign guidelines, with MTX as the anchor of RA therapy but in the real world clinical practice, due to poor response, some RA patients because of the side effects of csDMARDs difficult to continue to tolerate the drug, self-reduction, discontinuation of medicine, resulting in repeated rheumatic disease , initial treatment based on csDMARDs such as MTX is difficult to meet the desired clinical treatment objectives Such as the above-mentioned patients, the standard use of MTX, leflumet, Leigongto polysaccharide effect is not good, the second-line drug cyclophosphamide, thiopental adverse reactions 2018 China RA clinic guidelines recommend, clinically for patients with non-conforming RA treatment by csDMARDs, recommend a traditional synthetic DMARDs (csDMARDs) in combination with a biological formulation DMARDs (bDMARDs), or a targeted synthetic MARDDs (tsDDs) for treatment study of Elisabeth Lie and others, looked at the efficacy differences between other csDMARDs and bDMARDs in RA patients with inadequate Response to MTX The results showed that MTX and TNFi therapy was more effective than MTX and csDMARDs, and that more patients in the MTX-TNFi treatment group achieved low disease activity (DAS28 2.6) , in patients who received MTX-TNFi after failing treatment of MTX-csDMARDs, the disease was less active and had a worse lifespan than those who received MTX-TNFi directly after the failure of MTX Consider that bDMARD or tsDMARD treatment should be applied as early as possible in patients with poor efficacy of csDMARD So give the above patients a joint treatment of bDMARDs (TNFi, Adamu monotagh) and csDMARDs for refractory RA, TNFi shows its superiority tumor necrosis factor (TNF-alpha) is an important cytokine leading to RA joint lesions, and is a classic target of RA therapy (Figure 2) TNF alpha inhibitors are the most well-documented and widely used bDMARDs In this case, patients have used a variety of TNF-alpha inhibitors, why adamu monoantithed efficacy has the advantage? Figure 2 TNF alpha leads to RA joint lesions, is a classic target of RA treatment
showed in Figure 3, Adamum monotomatonica is the world's first all-human anti-TNF-alpha monoclonal antibody, low immunogenicity, not only conducive to reducing the incidence of drug allergies, but also not easy to lead to anti-antibody production, so that long-term use will not reduce the efficacy of the drug. Figure 3 Monoclonal Antibodies Development Process OPTIMA Study, showed that Adamu monotomatic therapy was effective, 2 weeks, and can continue to reduce joint pain and swelling symptoms (Figure 4) Figure 4 OPTIMA study: 28 joint swelling joint count (SJC) at the same time, Adamu monotoreactor can quickly reduce the invivia index, improve the system performance, 2 weeks can see a significant decline in CRP, and maintain a consistently low level Secondly, Adamu mono-antitherapy can quickly improve joint symptoms, so that can quickly improve physical function, return to normal life The results of the DE019 study showed that Adamu's single resistance was strong enough to inhibit the progression of joint damage (Figure 5) Premier study, which further observed the 10-year efficacy of the early RA treatment of Adamumssema and MTX, resulted in Figure 6, and the combined therapy effect of Adamu monotomaanda and MTX was better in inhibiting the progress of joint imaging Figure 5 DE019 Study: Progress in Joint Radiology at 26 weeks Figure 6 PREMIER Study: Radiology Progress during 10 Years of Treatment OPTIMAI.Phase Study in addition, in terms of safety, Adamu mono-resistance also shows a certain advantage expert tip High SJC and previous failures of treatment with multiple DMARDs are adverse prognosis factors for RA, and these patients are often more prone to radiation progression, leading to joint malformations, which seriously affect the quality of life A number of clinical studies at home and abroad have confirmed that Adamu monotoreactor can significantly inhibit the progress of radiology in RA patients, thus better controlling the progressofy of RA disease at the same time, for patients with refractive RA, especially those with failed bDMARDs treatment, studies have confirmed that Adamu monotomatorsiscantation can still benefit from clinical outcomes in most patients, with up to 83% of patients achieving EULAR response rate, and patient efficacy is guaranteed DANBIO studies confirm that Adamu monotoreactor is superior to other bDMARDs as in this case, in addition to poor efficacy, due to adverse drug events or intolerance caused by drug change is not uncommon Adamu zuma has the largest database of TNFi clinical trial safety, incorporated into 71 clinical trials worldwide, with a follow-up time of up to 12 years, to summarize and analyze the safety of Adamu stodrina therapy The results showed that the safety and tolerance of Adamu monototherapy RA was good, and the incidence of severe adverse events in long-term treatment was very low (e.g low incidence of shingles, not increasing the risk of abnormal blood lipids in patients, etc.) in addition, Adamum monoanti-anti-pre-injection needles or pens can be self-indering, every other week can be done Compared with intravenous infusion bDMARDs, Adamu monotoidation is less likely to occur, patients can go to the hospital outpatient treatment (no need for hospitalization), even at home self-injection treatment, more convenient, greatly save patients visit time, so that patients can better arrange personal life, but also reduce the burden on family members at the same time, compared with other other subcutaneous injections of bDMARDs with similar half-life, Adamu monotoreactor simply has faster onset and long-lasting efficacy, and it is believed that immediate efficacy and long-term safety are essential to enhance the treatment confidence and compliance of the majority of RA patients Expert Profile Wang Yongfu National Second Professor/Director Physician, M.D./ Postdoctoral Director of the Key Laboratory of Autoimmune Iniology of Inner Mongolia Autonomous Region, Director of the Medical Quality Control Center of Immunology of Inner Mongolia Autonomous Region, Executive Vice President of the Rheumatic Immunology Union of Inner Mongolia Autonomous Region, Director of Rheumatic Immunology Research Institute of Baotou Medical College and Director of The Department of Rheumatology Of an attached hospital is currently a member of the Inner Mongolia Medical Association's rheumatology credit committee, president of the Rheumatic Immunologists Branch of the Inner Mongolia Physicians Association, and a member of the clinical immunology branch of the Inner Mongolia Society of Immunology Vice Chairman of rheumatism immunology Branch of the Asia-Pacific Medical Bioimmune Society, Vice Chairman of the Chinese Society of Gerontology and Gerontology Osteoporosis , Standing Committee of the Chinese Rheumatic Immune Specialty Union, Member of the Rheumatic Immunologist Sedition Branch of the Chinese Physicians Association, Deputy Editor of the Chinese Journal of Osteoporosis, and Editorial Board of the Chinese Journal of Immunology and Rheumatology Xu Huiping Wang Yongfu Source: Medical Rheumatology and Kidney Disease Channel great reviews: 136erSp (no nickname) 2019-11-15 Comment: is wonderful and benefits from the (from: MedSci Medical APP )