GOLIMUMAB, TNF-α INHIBITOR, IN INTEGRATED METHODS OF THE TREATMENT OF AVASCULAR NECROSIS OF THE FEMORAL HEAD IN PATIENTS WITH PSORIATIC ARTHRITIS
Aim of the study – to investigate the efficacy and safety of golimumab in patients with psoriasis and psoriatic arthritis in the active phase, to which aseptic necrosis of the femoral head was diagnosed by MRI and who held courses with intra-articular injections of perftoran and dimexide. Material and methods. In a pilot clinical study, adult patients (n = 14) aged 32–49 (9 men and 5 women) with PsA, active Ps and early stages of aseptic necrosis of the femoral head took part. Ps in all patients has been diagnosed since childhood; PsA is diagnosed on average 8.2 years after the onset of Ps. All patients were given methotrexate as a baseline before enrollment. Evaluation of the effectiveness of treatment for PsA was performed in accordance with the criteria of the American College of Rheumatology (ACR), assessment of the prevalence of Ps in patients was carried out in accordance with the PASI75. Results and discussion. Evaluation of the results of golimumab therapy was performed at 12, 24 and 48 weeks. At week 12, ACR20 was achieved in 64 % of patients, ACR50 and ACR70 in 29 and 7 % of patients, respectively. By week 24 (after 6 injections), the response according to the criteria of the American College of Rheumatology (ACR20/50/70) was 86, 71 and 57 %, respectively. By the end of the 48th week the positive dynamics persisted: ACR 20/50/70 – 93, 86 and 79 %, respectively. The number of patients reached by the 12th week of PASI75 was 14 %. In 7 patients (50 %), aseptic necrosis in the stage of recovery, and a decrease in the degree of ANFH were observed by week 48 with MRI. Conclusion. Our experience has demonstrated the clinical effectiveness of golimumab therapy in all patients. In the majority (85.7 %) patients with psoriasis and psoriatic arthritis, a significant positive dynamics was achieved already 24 weeks after the start of therapy. It has been shown that treatment with golimumab is compatible with the courses of intraarticular injections of a drug mixture of perftoran and dimexide in the hip joint in patients with early stages of aseptic necrosis; positive dynamics is expressed in the inhibition of destructive changes in bone tissue and removal of edema of the bone marrow.
About Authors (Correspondence):
Polovinka M.P. – candidate of chemical sciences, associate professor of the department of organic chemistry, e-mail: firstname.lastname@example.org