The use of genetically engineered biological drugs in gastroenterology and rheumatology

Relevance: Immuno-inflammatory diseases are among the most common and severe human diseases, their frequency in the population is close to 10%. Autoimmune and inflammatory processes form the basis of the pathogenesis of inflammatory bowel diseases and rheumatic diseases. It is believed that the pathogenesis is based on abnormal reactions of the immune system, leading to the production of antibodies to their own cellular proteins and circulating immune complexes, with the development of granulomatous inflammation and vasculitis, as well as the influence of genetic factors. 

The prognosis and course of the disease largely depends on the possibility of early diagnosis, which allows for active therapy at the onset of the disease, which can significantly improve the immediate and long-term prognosis for inflammatory bowel diseases and rheumatic diseases and delay the development of disability. In 25% of cases, inflammatory bowel diseases can debut not only with symptoms from the gastrointestinal tract, but also with extra-intestinal manifestations, making it difficult to diagnose, delaying the start of adequate therapy, and worsening the prognosis of the disease. The lesion of the musculoskeletal system in inflammatory bowel diseases is an extra-intestinal manifestation of the disease and belongs to the group of seronegative spondyloarthritis (the so-called enterogenic spondyloarthritis). In axial spondyloarthritis, inflammatory bowel diseases occur in 4-6% of cases. Subclinical intestinal lesion in patients with ankylosing spondylitis - in 2/3 of cases (detected endoscopically, morphologically) occurs in 5-14% of cases with ulcerative colitis, in 10-20% - with Crohn's disease.

In the treatment of inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis), there are common drugs with a potential disease-modifying effect and common approaches - treatment to achieve the goal (T2T). However, in more than half of patients, treatment with standard methods, even at an early stage of the disease, does not reliably control the progression of the disease, the development of life-threatening complications, or is associated with severe adverse reactions.
One of the greatest achievements of medicine of the twentieth century is the pathogenetic justification and application of genetically engineered biological therapy for inflammatory bowel diseases and rheumatic diseases. Despite the lack of etiotropic treatment of inflammatory bowel diseases and rheumatic diseases, the rapid development of high medical and pharmaceutical technologies contributes to the creation of an increasing number of new medicines, which certainly increases the effectiveness of treatment of these diseases. Genetic engineering biological therapy is the use for therapeutic purposes of active substances and mechanisms that play an essential role in the functioning of the main biological systems of the body (antibodies, cytokines, cell receptors, their antagonists, etc.). However, not all genetically engineered biological drugs are equally effective in inflammatory bowel diseases and rheumatic diseases. 

As part of the program, we will study:    

1. Epidemiological, pathogenetic mechanisms of inflammatory bowel diseases and rheumatic diseases, the frequency and types of extra-intestinal manifestations of inflammatory bowel diseases and extra-skeletal manifestations in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis. 
2. Immunodiagnostics of inflammatory bowel diseases and rheumatic diseases.
3. The main indications for the appointment of genetically engineered biological drugs for inflammatory bowel diseases and rheumatic diseases, taking into account comorbidity.
4. Efficacy and safety of genetically engineered biological drugs in inflammatory bowel diseases and rheumatic diseases.
5. Causes of secondary inefficiency of genetically engineered biological drugs.
6. Indications, methods for switching and optimizing therapy with genetically engineered biological drugs within one class of drugs, an algorithm for switching to genetically engineered biological drugs with a different mechanism of action.
7. Monitoring the management of patients receiving genetically engineered biological drugs.
8. Prospects of modern biological therapy of inflammatory bowel diseases and rheumatic diseases. 

Base: MCSC MCSC named after A. S. Loginov DZM Department of Rheumatology, Department of Treatment of Inflammatory Bowel Diseases, MCSC named after A. S. Loginov DZM Department of Treatment of Inflammatory Bowel Diseases, MCSC named after A. S. Loginov DZM Department of Treatment of Inflammatory Bowel Diseases, MCSC named after A. S. Loginov DZM Department of Rheumatology. 

Internship Supervisors: Parfenov A. I., MD, Professor, Head of the Department of Intestinal Pathology, State Medical University MCSC named after A. S. Loginov DZM.
Lukina G. V., MD, Professor, Head of the Department of Rheumatology, State Medical University MCSC named after A. S. Loginov DZM.
Knyazev O. V., MD, Head of the Department of Treatment of inflammatory bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM.
Ruchkina I. N., MD, Senior researcher of the Department of Intestinal Pathology of the State Medical Institution MCSC named after A. S. Loginov DZM.
Kagramanova A.V., PhD, Senior researcher of the Department of Treatment of Inflammatory Bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM.
Lischinskaya A. A., PhD, Senior researcher of the Department of Treatment of Inflammatory Bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM.
Volnukhin E. V., Candidate of Medical Sciences, doctor of the Rheumatology Department of the State Medical Institution of the MCSC named after A. S. Loginov DZM.
Eremenko P. I., doctor of the Rheumatology Department, State Medical Institution of the MCSC named after A. S. Loginov DZM.
Savenkova N. A., PhD, Head of the Rheumatology Department of the State Medical Institution MCSC named after A. S. Loginov DZM.
Alexandrova E. N., MD, Head of the Immunological Laboratory of the State Medical Institution MCSC named after A. S. Loginov DZM.
Novikov A. A., MD, Senior researcher at the immunological laboratory of the State Medical Institution MCSC named after A. S. Loginov DZM.