EVIDENCE OF EFFECTIVENESS AND THE PLACE OF METHOTREXATE IN MODERN STRATEGIES FOR THE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

Golovach I.Yu.

• Feofania Clinical Hospital of the State Administration of Affairs, Kyiv

Summary. Rheumatoid arthritis (RA) is the most common inflammatory rheumatic disease, the characteristic feature of which is a progressive course with the formation of deformations and severe functional disorders of the musculoskeletal system. The treatment of rheumatoid arthritis and its improvements in the last two decades have been breath taking and a true paradigm of success in medicine. The review article presents the evolution of studies devoted to the study of the effectiveness of methotrexate in the treatment of rheumatoid arthritis. An analysis of clinical trials at different stages of rheumatoid arthritis — from preclinical arthritis to the advanced stage of the disease — was carried out. The results of numerous randomized clinical trials, their meta-analysis, and the experience of using the drug in real clinical practice testify to the high efficiency and good tolerability of methotrexate monotherapy in the early and advanced stages of rheumatoid arthritis, as well as in combination with other basic antirheumatic drugs and drugs of biological action. These data added to methotrexate the status of «gold standard» and «anchor drug» in the treatment of rheumatoid arthritis and conducting combined therapy. The rational use of methotrexate as a starting disease-modifying drug or a component of combined therapy is a key position of the modern T2T strategy for the management of patients with rheumatoid arthritis. Methotrexate is the only drug that can be used for the secondary prevention of rheumatoid arthritis, slowing the transition of undifferentiated arthritis to rheumatoid arthritis and inducing remission in early rheumatoid arthritis. The use of the subcutaneous form of methotrexate allows to increase the effectiveness of monotherapy and should become a mandatory component of an intensive strategy for the treatment of rheumatoid arthritis at all stages of the disease.