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| | Title: | How to Treat Rheumatoid Arthritis? | | Article: | Traditionally, non-steroidal anti-inflammatory drugs
(NSAIDs) go as the first-line therapy. Aspirin,
ibuprofen, naproxen, sulindac, indomethacin,
nabumetone, tolmetin relieve symptoms. However, NSAIDs
can not prevent joint destruction. Corticosteroids
efficiently reduce the symptoms of inflammation. Alas,
the side effects of corticosteroids are extremely
extensive. They cause weight gain, weak bones,
infection, acne, easy bruising, diabetes, facial
puffiness, stomach ulcers, eye cataracts and many
others. In case of active rheumatoid arthritis the
disease-modifying anti-rheumatic drugs (DMARDs) are
used. An example is methotrexate. Doctors often use
DMARDS together with corticosteroids and NSAIDs. Gold
compounds and anti-malaria drugs are also in use.
Other drugs include: azathioprine, cyclosporine A,
D-penicillamine, minocycline, sulfasalazine.
Majority of these drugs have serious side effects and
complications. Currently DMARDs are not well tolerated
and have serious side-effects. Corticosteroids are
still widely used, but doctors expect development of
newer and better DMARDs. Opiates and topical
lidocaine relieve pain.
Rheumatoid arthritis cause extra production of
pro-inflammatory cytokines (the regulating substances
of immunological system) and relative lack of
anti-inflammatory cytokines. This imbalance leads to
the development of cartilage and bone destruction. The
process erodes bone in the joints. Researchers found
biologic agents to block some specific cytokines. For,
example anti-TNF monoclonal antibodies infliximab and
adalimumab block TNF (Tumor Necrosis Factor, one of
the most potent cytokines). Another strategy use
etanercept (a soluble TNF receptor) that reacts with
TNF and prevents attachment of TNF to the real TNF
receptors on the target cells. An IL-1 receptor
antagonist anakinra prevents another type of
inflammatory response. Use of these biological agents
made significant and rapid clinical improvements with
low toxicity. Alas, there were some drawbacks after
long-term use. One was the need for parenteral
administration (needlesticks) which is unpleasant and
may lead to infections. Another was that the agents
cause an immune reaction of the body and loose
efficiency over time. Furthermore, monoclonal
antibodies and soluble receptors inhibit on the
extracellular level. More effective would be to block
intracellular inflammatory pathways.
Inhibition of p38 MAPK by oral drugs is the
possibility under investigation at present.
Weight loss, physiotherapy, joint injections, and
specialized tools for home activity help the patients.
In severe case patient may need joint replacement.
Some patients benefit form changes of diet and
lifestyle. Reducing stress, sleeping well, eating less
and highly digestible foods, eating yogurt, garlic,
vegetables, drinking sufficient volume of water may
help some patients.
| | Author: | Aleksandr Kavokin, MD, PhD | | System: | Joints | | Subject: | Rheumatoid_Arthritis | | Abstract: | Doctors often use
DMARDS together with corticosteroids and NSAIDs. Gold
compounds and anti-malaria drugs are also in use.
| | Website: | www.kavokin.com | | Time: | 16:32 | | Reference: | www.rdoctor.com | | Reference 2: | |
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Articles by Aleksandr Kavokin, MD, PhD
Doctor-Robot (Free section)