8 best drugs for arthritis

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

Most arthritis is treated as 'pure' therapy, as all but a very few arthritis are treated conservatively. Most often, arthritis is treated by physicians, therapists, and more 'narrow' specialists – rheumatologists. Rheumatologists are needed when joint inflammation is of a systemic nature and is associated with disorders in connective tissue and autoimmune pathology. Much less often, inflammatory diseases of the joints are the lot of infectious disease doctors and phthisiatricians, since there is, for example, brucellosis and even tuberculous arthritis. For example, in the event that an adult has an isolated, one-sided, long-term inflammation of the knee joint, that is, asymmetric drive, then this is almost always a tuberculous process.

Before talking about the drug treatment of arthritis, let us recall what it is, how arthritis differs from arthrosis, and how it happens. After all, speaking of arthritis, we mean a whole group of different diseases.

What is arthritis and what is it like?

Arthritis is an inflammatory joint disorder in which the classic symptoms of inflammation are the main symptoms. These symptoms have been known since ancient times, and their meaning for the doctor has not changed until now. The classic inflammatory signs that can be fully attributed to any arthritis are:

1. redness or redness of the local area, which indicates hyperemia, or inflammatory blood flow to the joint area.
2. swelling, which also indicates an inflammatory edema, which is caused by the tissue reaction to the release of biologically active substances into the inflammation focus;
3. a local increase in temperature, or a feeling of heat over the affected joint. This is a very characteristic component of inflammation, and speaks of an increase in metabolic processes in the lesion focus;
4. local pain is one of the most important symptoms of arthritis, but pain in the affected joint will be not only with arthritis, but also with arthrosis. The following will tell you how to easily distinguish arthritis from arthrosis;
5. finally, the last, fifth, major symptom of inflammation characteristic of arthritis is dysfunction. Dysfunction is lameness, limitation of mobility, development of stiffness in the joint, and so on.

All symptoms of arthritis are extremely simple and straightforward, and all of them can be determined by oneself, and very quickly. But sometimes they talk about arthrosis of the joint. How does arthritis differ from arthrosis, and how not to confuse these diseases?

Differences between arthritis and arthrosis

First of all, the ending of a medical term. All medical noun terms that end in '-it' are the name of inflammatory diagnoses: encephalitis, peritonitis, sinusitis, arthritis. All terms that end in '-oz' are already non-inflammatory diseases, in this case, there is a pathological growth and change in certain tissues. For example, sclerosis is a vascular pathology in which they become fragile and hard. Amyloidosis is the formation of an abnormal amyloid protein, chondrosis is a modification of cartilage tissue in which cartilage becomes fragile and loses elasticity.

Finally, arthrosis is a pathology of the joints in which the articular surfaces change, a crunch appears during movement, the production of synovial fluid or lubricant decreases, and all this also leads to limited mobility in the joints and the occurrence of pain. But at the same time, arthrosis does not have such pronounced inflammatory signs. On the contrary, an attentive doctor can distinguish arthritis and arthrosis by complaints, even if there is no obvious redness of the skin and a local increase in temperature over the affected joint.

Here are the hallmarks of this difference. In a patient with arthrosis, joint pain occurs immediately after the start of movement, and then the joint is gradually 'worked in'. A very characteristic symptom is the lameness of an elderly person immediately after getting out of bed in the morning, he needs to disperse, and during the day he gets better. In the case of arthritis, the situations are reversed, the joint needs rest, and rest reduces the severity of inflammation, edema decreases, and then it becomes easier to walk, although this does not last long.

Arthritis and arthrosis have characteristic different symptoms on a radiograph, and on an ultrasound examination, as well as on tomography, but we will not dwell on this.

Arthritis can be classified in a number of ways. If one joint is affected, it is monoarthritis, if several joints are affected, then it is oligoarthritis, if there are many, then it is polyarthritis. Also, arthritis can be primary or secondary, depending on which process led to the inflammation. Inflammatory damage to the joints can be infectious in nature, for example, with the same brucellosis, or Lyme disease, inflammation can also have an metabolic character. The classic example is an attack of gout, which affects the base of the big toe. A large number of arthritis are systemic lesions of the connective tissue, and can be of autoimmune, rheumatic origin. A classic example is rheumatoid arthritis.

If arthritis is of systemic origin and is a symptom of connective tissue damage, there may be other signs. These are vascular lesions, hemorrhagic syndrome, vascular thrombosis, lesions of the peripheral nervous system in the form of mononeuritis or polyneuropathy. The patient may have concomitant eye damage, dry or effusion pleurisy and pericarditis, and other severe symptoms. This diffuse lesion is treated with serious medications. These are corticosteroid hormones, cytostatics and immunosuppressants, which will be discussed below. But in most cases, the treatment of simple arthritis, which is not complicated by the pathology of internal organs, is much easier to treat.

Pharmacotherapy, or drugs for arthritis

Since arthritis, as an inflammation of the joints, has been known since ancient times, and unlike inflammatory processes in the internal organs, all the symptoms can be seen with our own eyes, the very first treatment of arthritis was carried out with folk remedies. There is still a popular custom to apply burdock, or cold, to the site of inflammatory edema and redness, which leads to relief. But this method of treatment is purely symptomatic. Yes, relieving symptoms is a very important step in treatment, especially at the very beginning.

Naturally, the most important and unpleasant symptom that reduces the quality of life is inflammatory, intense throbbing or persistent pain in the joint at rest, as well as when walking. Unfortunately, the elimination of pain cannot affect inflammation, therefore, the main and main group of drugs will be non-steroidal anti-inflammatory drugs, or NSAIDs. They stop the inflammation itself, and are extremely widely used for arthritis. This is intramuscular injection, tablets, intraarticular injection. To eliminate inflammation, especially chronic, patients can use local drugs with NSAIDs – these are various ointments, creams and gels, liquid balms, bischofite, ozokerite, and other drugs that improve the exchange in joints and eliminate inflammation. It is possible to use local remedies both at the stage of stable remission, and with an exacerbation, and with an acute process.

In addition to the classical treatment regimens for arthritis, there are also those drugs that cannot be simply bought in pharmacies. We are talking about modern treatment of severe arthritis, which are treated for life. These are basic drugs, cytostatics, complexing agents and immunosuppressants, widely used in rheumatology.

A large group of the most modern means for the treatment of arthritis and systemic pathology is made up of the so-called monoclonal antibodies, created artificially by the methods of molecular genetics. These are inhibitors of certain elements of inflammation, agents that fight immune aggression, blockers of the pathogenic function of lymphocytes and interleukin. All this can already be called heavy artillery, and these medicines will be discussed at the end of the article.

It should be said that, in addition to the drugs of the main line, there are always aids. So, if, in addition to inflammation of the joint, muscles are affected, then central muscle relaxants are used, which reduce muscle spasms and reduce pain. If arthritis develops in the presence of stress and generalized anxiety disorder, antidepressant medication will help reduce pain. If the patient does not tolerate anti-inflammatory drugs well, and he has a stomach ulcer or erosive gastritis, then modern drugs for the treatment of ulcers, that is, proton pump blockers, are always used as a cover. In some cases, the intake of vitamins and trace elements, physiotherapy treatment, and a change in the load on the joint are indicated.

This article will consider drugs that are essential. We will not talk about gastroprotectors, about antidepressants, there are separate articles for this, and we will begin the drug review with a large group of non-steroidal anti-inflammatory drugs. For each drug, the international non-proprietary name (INN) is given first, and then the name of the original drug and its generics, or commercial copies. The range of prices will be given from the most expensive to the cheapest denomination. Prices are valid for retail sale of drugs in the fall of 2019 in the Russian Federation. The order in which drugs are listed is not a rating scale or rating, they are arranged in no particular order according to their classes or groups.

The best drugs for arthritis

Nomination	a place	Name of product	price
NSAIDs	1	Meloxicam (Movalis, Amelotex, Artrozan, Genitron)	RUB 520
	2	Nimesulide (Nimesil, Nise, Nemulix, Nimulid, Prolid)	RUB 624
	3	Ketorolac (Ketanov, Dolak, Ketokam)	226 r
Hormonal intra-articular drugs	1	Betamethasone (Diprospan)	303 RUB
Modern treatment for severe arthritis	1	Penicillamine (Cuprenil)	1 370 rub.
	2	Methotrexate	RUB 314
	3	Leflunomid (Arava, Raleph, Elaphra)	868 RUB
	4	Sulfasalazine-EH	329 r

NSAIDs

NSAIDs are the main and practically irreplaceable group of drugs. They fight both the symptoms listed above and block the mechanism of inflammation itself, inhibiting a special enzyme – cyclooxygenase. If a drug selectively blocks type 2 cyclooxygenase, then the drug is called a selective drug. It is safer, more selective, and has fewer side effects associated with older, 'non-selective' drugs in this group. As a rule, all anti-inflammatory nonsteroidal drugs act on three 'whales' of inflammation:

1. fever, or fever (antipyretic);
2. pain;
3. inflammation itself as a pathophysiological process.

Antipyretic properties are not interesting to us, since with arthritis there is rarely a general increase in temperature. Therefore, drugs like Aspirin, Paracetamol, Ibuprofen are of little use for acute and chronic arthritis. But drugs that selectively relieve pain, reduce swelling, redness and restore function are very appropriate. The most popular ones are listed below.

Meloxicam (Movalis, Amelotex, Artrozan, Genitron)

Popularity rating: 4.9

Movalis is a highly effective German drug that is available in ampoules for intramuscular administration and in tablets. In acute arthritis, especially of a rheumatic or systemic nature, first, on the first day, the drug is administered intramuscularly, in parenteral form, and then switched to tablets for maintenance therapy. It goes without saying that if we are talking about acute infectious, or purulent arthritis, then treatment should be started with antibiotics and antibacterial drugs, and not with relief of secondary inflammation.

Movalis relieves pain well, reduces temperature, inhibits the synthesis of prostaglandins. It is indicated, in addition to acute and chronic arthritis, with pain in the lower back, with protrusions and hernias of discs, with rheumatoid arthritis and with ankylosing spondylitis, or ankylosing spondylitis. It is usually prescribed for acute pain syndrome, 1 tablet 15 mg, once a day. After achieving the effect, the dose is halved. The maximum dosage should not exceed 15 mg per day, that is, one tablet is the maximum daily dose. Movalis is produced by the Berlin-Chemie company, and the cost of a pack of 10 tablets of 15 mg each ranges from 370 to 540 rubles. The cheapest domestic analogue of Pranafarm will cost from 43 rubles. up to 100 rubles. That is, the domestic analogue is 16 times cheaper than the original drug. We hope that the quality of treatment is not 16 times worse.

Advantages and disadvantages

This is a highly active drug, and although it belongs to selective, it should still be taken in the shortest possible courses, and immediately reduce the dose. It is contraindicated, like many NSAIDs, with a combination of nasal polyposis with bronchial asthma and aspirin intolerance. The main contraindications are active stomach ulcers, erosive gastritis in the acute stage, Crohn's disease, or ulcerative colitis, severe liver damage, threatening gastric bleeding, pregnancy, lactation and age up to 12 years. The drug quite often has side effects such as headache and gastrointestinal disorders, the drug can interact with other drugs, which must be taken into account when prescribing.

Nimesulide (Nimesil, Nise, Nemulix, Nimulid, Prolid)

Popularity rating: 4.8

Nimesulide is one of the few drugs from the NSAID group that is not available in ampoules for parenteral administration. Most often these are powders for solution in water and oral administration, tablets, as well as various creams and gels. One remedy indicated for joint pain, arthritis and back pain, even for muscle and toothache and soft tissue injuries, is Nimesil. He has a softer effect than Movalis. It not only fights inflammation and relieves pain, but also helps to lower the temperature, which can be beneficial for colds. The drug can even be used for painful menstruation, and although after its withdrawal the symptoms resume again, but as part of complex therapy it can be indispensable.

It is advisable to use Nimesil and its analogues, one packet twice a day, the duration of admission should not exceed 2 weeks. Nimesil is produced by the same Berlin-Chemie company, and one pack of 30 sachets, designed for such a two-week course, will cost from 600 to 750 rubles. Domestic sachets of the Marbiopharm company can be purchased at a price of 250 to 590 rubles, but the cheapest are the tablets of the company of the same name. Even a dosage of 20 pieces is sold in pharmacies at a price of 40 rubles and even lower.

Advantages and disadvantages

Contraindications for taking Nimesil are the same as those of Movalis. It is not recommended in case of severe blood clotting disorders, alcoholism and drug addiction. It is also contraindicated in pregnant women and nursing mothers, and can cause side effects characteristic of NSAIDs, of which nausea, diarrhea, or even vomiting are most common. As in the previous case, any nimesulide should be used with the minimum effective doses and the minimum short course. It is also undesirable to combine this drug with other drugs from the NSAID group.

Ketorolac (Ketanov, Dolak, Ketokam)

Popularity rating: 4.7

Unlike the two above-described drugs, ketorolac, or Ketanov, has a particularly pronounced analgesic orientation. It does not have such a good effect on general inflammation, practically does not reduce the temperature, but on the other hand, acute pain after its application decreases significantly, or even completely disappears. The ability of Ketanov and its analogs to relieve pain is close to that of narcotic analgesics and Tramadol. Even severe toothache and pain after surgery are subject to him. The drug is a derivative of acetic acid, with very intense pain it is used intramuscularly, but most often it is used in tablets, this is quite enough. Ketorolac can be considered the strongest pain reliever of all the other drugs in this group.

It is necessary to use the medicine in tablets, one tablet daily, the maximum daily dose for very severe pain in the joints should not exceed 40 mg, and the duration of the course should not exceed five days, regardless of the dose. Thus, Ketorolac and its analogs are not a remedy for long-term treatment, but a drug for emergency therapy. All analogs are very inexpensive, for example, Indian Ketanov can be purchased at a price of 40 to 55 rubles, in a package of 20 tablets.

Advantages and disadvantages

Ketanov has a huge, significant advantage in the form of a powerful analgesic effect, and the Ministry of Health of the Russian Federation gets a huge and fat minus, since Ketanov will not be sold to you without a prescription in a pharmacy, although it does not affect opioid receptors, and has nothing to do with drugs. Apparently, if you have severe toothache or joint pain, then you must first beg for a prescription from a therapist, although more recently this drug could be purchased as a life-saving pain reliever. As for the rest of the disadvantages, this is a standard set of contraindications, including pregnancy, lactation and age under 16, and the same set of side effects. At the same time, a very good plus is the low price, but this plus is immediately lost due to the complete unavailability of the drug on the free market.

Chondroprotectors

The section on chondroprotectors will not contain specific names of drugs, and is created for general information only, since they 'do not work'. Chondroprotectors, that is, the substances that make up cartilage, protect it from destruction and are structural components of normal cartilage. A person gets them from the synovial fluid, since the cartilage does not have blood vessels. Including the cartilage of the joint affected by arthritis. These substances are chondroitin sulfate and glucosamine.

Chondroprotectors are all OTC drugs that are considered dietary supplements, but none of these drugs is proven to be effective, either in acute and chronic arthritis, or in dystrophic degenerative processes.

The thing is that chondroprotectors in the digestive tract are split into elementary components, which in their quantity and quality are no different from the same nutrients that are formed in the intestines after eating ordinary jelly and jellied meat, meat and fish dishes. Therefore, taking chondroprotectors, such as Elbona, Alflutop, Inoltra, is not justified. If chondroprotectors are applied intramuscularly, then this also will not lead to the desired result, since the cartilage has no vessels and will not receive these ingredients.

Therefore, manufacturers of chondroprotectors go to some tricks. So, the drug Teraflex Advance will help, but only because, in addition to the components supposedly protecting the articular cartilage, it additionally contains the non-steroidal anti-inflammatory drug ibuprofen.

Hormonal intra-articular drugs

But what to do if intramuscular and tablet drugs from the group of non-steroidal anti-inflammatory drugs do not help? Then, for special indications, hormonal agents are used, and when it comes to intra-articular injections, then, first of all, hormones are meant.

Betamethasone (Diprospan)

Popularity rating: 4.9

The best known and widely used topical glucocorticosteroid is betamethasone. It is administered as a sterile suspension. This is a fairly strong glucocorticosteroid hormone, which is used in the form of intraarticular and periarticular injections. This drug is administered both intramuscularly, at a dose of 1 to 2 ml, and intra-articular. Intra-articular administration in a dose of 0.5 to 2 ml quickly and for a long time eliminates pain, restores mobility in the joints, and the effect of just one injection can be long-lasting: up to 1 month, and even longer.

The drug Diprospan is produced by the well-known company Schering-Plow, from Belgium, and the drug can be purchased in the form of one small package of 1 ml, which may be enough in case of damage to small joints for four joints, and in the case of a large joint – for one joint. The cost of such a package ranges from 230 to 300 rubles. There is also an analogue, Betaspan depot, of Ukrainian production. Here in the package there will already be not one ampoule, but as many as five, at a price of 450 to 500 rubles. per packing. Accordingly, the cost of this tax will be about 4 times cheaper if we consider the price of one ampoule.

Advantages and disadvantages

Plus Diprospan – in fast and long-lasting action, western quality, low price. However, this drug cannot be used intravenously or subcutaneously, but it is undesirable to prescribe it immediately, it is still a strong, reserve medicine. Like any glucocorticosteroid, it can cause increased potassium release from the body, sodium retention and edema, weight gain, high blood pressure, and osteoporosis. With prolonged use, it can induce steroidal diabetes mellitus, intensification of various manifestations of gastritis, exacerbation of gastric ulcer, and other complications and side effects characteristic of glucocorticoids.

Diprospan is also contraindicated in the presence of acute infectious arthritis, since, as mentioned above, infectious arthritis is not treated with pathogenetic agents that affect the inflammatory mechanism, but with etiotropic therapy, that is, they affect the immediate cause of arthritis – the pyogenic flora.

Modern treatment for severe arthritis

But there are such forms of arthritis, when you need to be treated all your life, and taking medications should be long-term. The tasks of these drugs are already different – to influence the autoimmune process, reduce the rate of cell division, and thereby eliminate inflammatory symptoms. Simply combating inflammation by blocking cyclooxygenase and rupture of the inflammatory cascade cannot be avoided. Such drugs are called basic agents, and belong to the classes of complexing agents, cytostatics and immunosuppressants. No one will prescribe such drugs to a patient with symptomatic arthritis, which can be cured by other means, for example, fighting infection with tuberculous arthritis or a rational regime of work and rest for occupational inflammation of the joints. Basic funds are prescribed for those systemic processes when patients can be given a disability. The classic diagnosis is severe, progressive forms of rheumatoid arthritis, or ankylosing spondylitis (ankylosing spondylitis). Let's list the most well-known drugs from the group of basic drugs.

Penicillamine (Cuprenil)

Popularity rating: 4.9

Penicillamine (not to be confused with penicillin!), Which is sold under the commercial name Cuprenil, is available in tablets and is classified as a complexing compound. This means that it forms large-molecular structures with atoms of copper, iron, cobalt, calcium and other trace elements. The medicine belongs to antirheumatic specific drugs.

Penicillamine is indicated for severe forms of rheumatoid arthritis, in the presence of systemic scleroderma, as well as Wilson-Konovalov's disease, when too much copper accumulates in the body, and it needs to be bound and removed from the body. Shown Cuprenil and severe metal poisoning, for example, lead, or mercury. The medicine is used only as directed by a rheumatologist, half an hour before a meal or after a meal two hours later if there is a diagnosis such as rheumatoid arthritis.

The starting dose starts at 250 mg per day, then the dose is slowly doubled according to a special scheme until a significant improvement is achieved, and then the dose is gradually reduced. Thus, the minimum effective dose is achieved. If the medicine does not help within 6 months from the start of treatment, then this remedy is considered ineffective. Usually the maintenance dosage is 600-750 mg per day. The drug is produced in tablets of 250 mg, 100 tablets in a bottle. Cuprenil is produced in Poland by the pharmaceutical company Polfa, and the packaging costs an average of 1,300 rubles, which is not cheap, given the duration of use.

Advantages and disadvantages

Like any serious drug, Cuprenil is contraindicated in renal failure, in children, pregnant and lactating women, in the presence of agranulocytosis in the blood, and in renal failure. Cuprenil 'does not like' combinations with cytostatics. Unpredictability can be considered a big disadvantage; in about 30% of patients, the drug may be ineffective, but this will be known only a few months after the start of treatment. After all, this drug immediately 'does not work', and even a week or two after the start of treatment it is impossible to say whether it will help or not.

In addition, Cuprenil can cause a large number of side effects, such as vomiting and stomatitis, skin rashes and taste distortions, eosinophilia and interstitial pneumonitis. Prescribing Cuprenil, it must be remembered that it is a vitamin B6 antagonist, and therefore, with prolonged treatment, it can cause pyridoxine deficiency and disorders of the peripheral nervous system, up to polyneuritis, which disappears after stopping treatment.

Methotrexate

Popularity rating: 4.8

Methotrexate is the next basic cytostatic drug that is used for various forms of arthritis, including severe rheumatoid arthritis and psoriatic arthritis. In addition, it is indicated for various malignant neoplasms, lymphogranulomatosis. It belongs to the antimetabolites of folic acid, therefore, while taking methotrexate, the patient must receive rather high doses of folic acid in order to avoid complications, according to certain schemes. This medication is also prescribed according to special schemes, and it really slows down the progression of rheumatoid arthritis.

Methotrexate is produced in tablets of 5 mg, and one of the most famous and effective is Methotrexate made in Austria by Ebeve Pharm. 50 tablets will cost from 300 to 380 rubles.

Advantages and disadvantages

Methotrexate can cause both early and delayed side effects. Various gastrointestinal symptoms develop early, ulcerative stomatitis of the oral mucosa may develop, and headache occurs. As for the late, or delayed side effects, they are experienced by up to a third of all patients. This is the development of anemia, a decrease in leukocytes in the blood, a drop in platelets. 1% of patients suffer from drug-induced pneumonitis, and this is a serious complication that can even be life-threatening. A significant decrease in immunity against the background of methotrexate leads to the development of opportunistic infections, fungal infection occurs, and even pneumocystis pneumonia. Methotrexate has a harmful effect on the liver, therefore, during treatment, it is necessary to monitor the indicators of liver enzymes.

Leflunomid (Arava, Raleph, Elaphra)

Popularity rating: 4.7

Arava is a modern immunosuppressant that also belongs to the basic drugs. This medicine is indicated, first of all, for rheumatoid, and secondly, for severe psoriatic arthritis. Arava is available in tablets, and at the beginning it is taken at 100 mg daily for 3 days, and then they switch to a maintenance dosage in a small dose, from 10 to 20 mg per day. As in the case of Cuprenil, the initial therapeutic effect appears no earlier than a month or a month and a half after the start of treatment, and in the case of successful therapy, the patient feels better and better, such a therapeutic effect can increase within six months, gradually reaching a maximum.

This tool is produced by Sanofi Aventis. One package of 30 10 mg tablets will cost from 1200 to 3500 rubles, which will be enough for a month of maintenance therapy. If the patient is just starting treatment, then during the first three days he will just use the entire bottle, since he takes 10 tablets daily. But there is a way out – this is domestic leflunomide, which is produced, for example, by the company Canonpharm Production: one of the same packaging will cost less than 1,000 rubles, within 950 rubles.

Advantages and disadvantages

Like all basic drugs, it is contraindicated in pregnant women, lactating women and in persons under 18 years old, you should not take Arava with severe liver and kidney dysfunction, with severe infections, leukopenia, bone marrow suppression and with severe immunodeficiencies. In addition, it has an embryotoxic effect, and if a man taking this medicine conceives a child, then he should be warned about the high risk of intrauterine malformations.

The drug also produces significant side effects, ranging from diarrhea and nausea to tendovaginitis and possible ligament tears and hair loss. The content of leukocytes in the blood falls, anemia develops, and sometimes allergic reactions occur. Therefore, it is necessary to take such a medicine only under the supervision of specialists and these analyzes.

Sulfasalazine-EH

Popularity rating: 4.6

Sulfasalazine is a medicine that rheumatologists have known for a very long time. They take advantage of its significant side effect as it is not 'pure' anti-inflammatory. In fact, this is a drug for intestinal infections from the sulfonamide group, but it also has a pronounced anti-inflammatory effect when it accumulates in the intestinal walls and releases its special metabolites.

Therefore, gastroenterologists are especially fond of using this medicine in the treatment of ulcerative colitis, which also refers to diseases of the connective tissue. Sulfasalazine is also widely used in rheumatoid arthritis, including in its juvenile form.

In the case of rheumatoid arthritis, an adult patient is prescribed a 500 mg sulfasalazine tablet, once a day during the first week, during the second week the dose is doubled, and during the third week the dose is 1.5 g per day, that is, three tablets. The course of treatment is long, up to six months, with the constant supervision of a specialist. Sulfasalazine is an inexpensive drug: for example, the Krka company offers a package of 50 tablets of 500 mg at a price of 230 to 450 rubles, and the domestic company Ozone sells its sulfasalazine in pharmacies at prices up to 200 rubles.

Advantages and disadvantages

Sulfasalazine does not belong to the basic drugs, so it has milder contraindications. In addition to severe liver and kidney disorders, these are lactation, anemia, hypersensitivity to sulfonamides and children under 5 years of age. It also causes some side effects on the part of various organ systems, stains urine bright yellow, and can also stain soft contact lenses yellow. In case of an overdose, nausea and vomiting may occur, sulfasalazine reduces the absorption of folic acid, so it must also be added during treatment.

Modern monoclonal antibodies

Finally, in conclusion of this review, it is necessary to recall modern drugs, for the production of which modern molecular genetic technologies are needed. As a result, exactly the same, or monoclonal antibodies are obtained, which help a person to produce special microorganisms, for example, these are industrial strains (races) of special yeasts.

But in order for yeast to start producing monoclonal antibodies in addition to alcohol, special genes must be introduced into their genetic code, into their hereditary information, regions of nucleic acids that are artificially formed, and which were not previously found in yeast. To create such an artificial gene that codes for the creation of proteins of the desired antibodies, a very high-tech industry is needed. Moreover, this genome should not only be created, it is implanted into a yeast cell, and then propagated and maintained by this clone. Thereafter, the produced antibodies are collected in 'pure form'. Thus, yeast becomes a supplier of an extremely important product, a kind of 'medical animal'.

Several such drugs are known that are used in rheumatology, including for the treatment of arthritis. These are Remicade and its analogs, which inhibit tumor necrosis factor (TNF), and belong to immunosuppressants. This is rituximab, or Mabthera. MabThera is an anticancer drug that alters the function of B-lymphocytes and is used for active severe rheumatoid arthritis. This is a drug like Orencia, or a T-lymphocyte stimulation blocker. The latter drug is also used to improve the activity of adult patients with severe active rheumatoid arthritis.

It should be recalled that all these medications are prescribed only when the patient does not tolerate the basic drugs well, or does not respond to them actively enough. There are quite a few such situations, because many basic drugs are aggressive and cause a large number of side effects, for example, the same Methotrexate.

All monoclonal antibodies are usually injected intravenously as an infusion, and their cost is very, very high, so patients have to literally fight with officials for many of them, despite the fact that many of them must be given to the patient free of charge. So, the cost of the cheapest infliximab (generic Remicade) is from 11 to 26 thousand rubles per bottle, and in the case of Remicade, that is, the original remedy, the price can go up to 53 thousand rubles. MabThera also costs in the range from 13 to 45 thousand rubles, and if we are talking about a solution for subcutaneous administration with a high dosage, then the cost can go up to 120 thousand rubles. The drug Orencia, or abatacept, is also quite expensive, and the interleukin receptor blocker, or Actemra, can also cost up to several tens of thousands of rubles in its price.

Why are these drugs so expensive? First of all, they are very difficult to obtain; even the most advanced pharmaceutical production is not enough for this, this is molecular genetic, biotechnological production. Monoclonal antibodies act very selectively, and therefore, although they have side effects, nevertheless, the treatment process can be controlled with a high level of prediction.

That is why all these modern means are extremely effective, and in patients with severe arthritis and a high risk of rapid disability, monoclonal antibodies, if they do not stop this process, can still significantly postpone the onset of disability, for example, by making it twice as slow. Therefore, if, according to statistics, a person becomes disabled after 7 years, then when using monoclonal antibodies, he will be as much as 14 years, and maybe longer, capable of self-service and an active life. Believe me, this is not a short time.

The popularity rating is based on the analysis of demand data from the wordstat.yandex.ru service.

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Attention! This rating is subjective and does not constitute an advertisement and does not serve as a purchase guide. Before buying, you need to consult with a specialist.