rheumatoid arthritis ( ra ) is an autoimmune rheumatic disease with unknown etiology that occurs in approximately 1% of population worldwide . the majority of rheumatologists believe that early onset of therapy ( within three months ) must change the course of ra . arthrofoon ( affine - cleared ultra - low doses of antibodies to human tnf- : a mix of homeopathic dilutions c12 , c30 and c200 ) is a disease - modifying antirheumatic drug ( dmard ) aproved by the russian ministry of health for the treatment of ra in 2001 . it modifies production / activity of endogenous tnf-. animal studies showed that arthrofoon induced a systemic anti - inflammatory response and exerted an analgesic effect . in collagen - induced arthritis in rats , arthrofoon influenced systemic proinflammatory cytokine production , reducing interleukin ( il)-1 , il-6 and tnf- serum concentration . our study enrolled 114 outpatients ( aged 20 - 73 years ) with early ra . we investigated the efficacy and safety of nsaids ( diclofenac 100 mg / day compared with nimesulide 200 mg / day for the first month or longer at the request ) and dmards ( methotrexate 7.5 - 15 mg / week per os compared with arthrofoon under the tongue in an initial dose of 8 tablets / day with a maintenance dose of 3 - 4 tablets / day at condition improvement or combination of two last drugs in the same doses for two years ) . the treatment of one of the outpatients with arthrofoon as a newer drug for basic therapy is analyzed here . a 28-year - old russian woman with initial diagnosis of reactive arthritis ( rea ) was enrolled in a clinical study for early arthritis at the chair of polyclinic therapy of the orenburg state medical academy ( russian federation ) . patient complained of the pain and swelling of hands , wrists , elbows , knees , ankles and foot , as well as morning stiffness for 30 minutes with no history of fever . all symptoms started two weeks ago . before the advent of joint complaints , she had history of chicken pox and conjunctivitis . the disease activity score 28 ( das28 ) was 4.97 points ( moderate activity ) . the results of serum c - reactive protein ( crp ) testing were positive ( two points on three - point scale ) . the undifferentiated arthritis was taken into consideration and patient was treated with oral nimesulide ( nise of dr . reddy 's laboratories ltd , [ hyderabad ] , india ) 100 mg twice a day to reduce inflammation . during differentiation of diagnosis with reactive arthritis immunosorbent assay of blood , the antibodies ( immunoglobulins g ) directed to mycoplasma hominis and ureaplasma urealyticum were found in titers 32 and 41 units , respectively . no atypical agents were found by method of polymerase chain reaction after scraping the surface of the cervix . search of ra markers by method of enzyme - linked immunosorbent assay of blood established rising of antibodies against modified citrullinated vimentin ( titer 28.55 u / ml ) and normal level of igm - rf ( 3.6 u / ml ) . the x - rays of patient 's hands showed no bone lesions . ultrasonography of radiocarpal and second through fourth metacarpophalangeal ( mcp ) joints detected tenosinovitis of the extensor carpi ulnaris , synovitis and periarthritis of the mcp joints of the hands , and symmetric erosions of the second mcp joints ( total score of erosions = five ) ; a minor synovitis and periarthritis of knee joints . after two weeks , the secondary diagnosis was established , namely : probable ra , seronegative , very early stage , activity ii , erosive ( radiological changes were not revealed ) , functional class i. the dynamics of pain vas , patient 's and physician 's global assessments of disease activity are shown in figure 1 . treatment has been continued by arthrofoon from eight tablets daily ( two tablets , four times a day ) to three tablets daily ( one tablet , three times a day ) after five days . dynamics of some clinical parameters during the two - year treatment with arthrofoon ( vas 0 - 100 mm ) : ptga  patient 's global assessment of disease activity ; pnga  physician 's global assessment of disease activity ; pain vas  pain score on visual analog scale after one month , the moderate response to the treatment according to european league against rheumatism ( eular ) criteria and according to american college of rheumatology ( acr ) , 20% improvement ( acr20 ) response rates were found . ultrasonic signs of tenosinovitis of the radiocarpal joints and synovitis of mcp joints were not visualized and other inflammatory changes decreased [ figure 2 ] . erosions of second mcp joints of both hands are identified ( arrow ) after 24 months , the das28 decreased to 2.34 points that corresponded to remission according to eular criteria and 50% improvement has been noted according to acr criteria . , the patient received three two - week courses of the treatment with nimesulide only . radiological signs of periarticular osteoporosis were found after two years and they confirmed the diagnosis of ra . the young age of the patient and the recent conjunctivitis became the reasons for diagnosis of ra by rheumatologist . the probability of a trigger role of an atypical infection ( mycoplasma and/or ureaplasma ) as well as the originator of chicken pox in the development of autoimmune disorders in patient has not been excluded . according to new 2010 acr / eular classification criteria for ra , patient had score of 6/10 ( > 10 involved joints with at least one small joint = five , abnormal crp = one ) . although duration of symptoms was less than six weeks at first visit , this score evaluation after the exclusion of rea could be evidence of early ra and basis for initiating disease - modifying therapy . a short history of the disease allowed recommending of low - dose inhibitor of tnf-. the treatment with arthrofoon for two years demonstrated sustained improvements in disease activity , ultrasonic findings and reduction in the requirement for nsaids . early prescription of ultra - low doses of tnf- antibodies arthrofoon for two years led to clinical improvement and delay of radiological disease progression in patient with probable ra of moderate activity initially .
the main aim of treatment of early rheumatoid arthritis ( ra ) should be to achieve clinical remission to prevent structural damage and physical disability . 
 arthrofoon modifies production / activity of endogenous inhibitors of tumor necrosis factor- ( tnf- ) . 
 the sublingual rout is the most acceptable to ambulatory treatment because it does not produce the adverse reactions associated with intravenous therapy . 
 the treatment with arthrofoon in outpatient with early ra is analyzed here . 
 this report is devoted to the 28-year - old russian woman who received arthrofoon due to suspicion of early ra . 
 the strategy of early prescription of ultra - low doses of tnf- antibody within two years was confirmed by the clinical improvement and delay of radiological disease progression in patient with undifferentiated arthritis or probable ra initially .