We will go through overview of treatment of Rheumatoid arthritis.
But for better understanding please see our previous video (rheumatoid arthritis autoimmune drama).
With the progress of the disease and in addition to nonpharmacological approaches, the pharmacological management of RH includes non-steroidal anti-inflammatory drugs NSAIDs
and disease modifying antirheumatic drugs abbreviated as DMARDs
before advancing towards new biologic drug group.
Corticosteroids therapy could be initiated at any time during the disease course.
Starting with NSAIDs which include very popular drugs such as aspirin, ibuprofen, indomethacin, celecoxib and naproxen.
NSAIDs work mainly through inhibition of cyclooxygenase isozymes abbreviated as COX1 and COX2
But bear in your mind that They don’t slow the progression of the disease.
They just alleviate the inflammatory manifestations (Pain and Stiffness)
NSAIDs have serious GIT side effects such as peptic ulcer, bleeding and perforation. In addition to increased risk of ischemic heart disease.
Now…. DMARDs the abbreviation for disease modifying antirheumatic drugs.
Unlike NSAIDs they slow the progression of joint destruction.
They are chemically and functionally unrelated agents.
They are nonselective inhibitors of the immune system.
They work through various mechanisms on different stages of immune system.
And in sometimes their exact mechanism of antirheumatic action is not clear.
Indeed, they are different agents with different side effects.
Another main difference from NSAIDs is that they have slow onset of actions, it might take weeks to start their antirheumatic effect.
Biologics the most advanced development in management of rheumatoid arthritis
are proteins produced by biotechnological modification of human genes.
Like DMARDs
They slow the progression of joint destruction
However, unlike DMARDs
The focus on specific immune targets, specifically the cytokines
That’s why they called snipers.
Among various cytokines involved in the immune response, the TNF alpha is the current main target for various biologic agents.
For example, infliximab and adalimumab are monoclonal antibodies against TNF alpha molecules
Whereas, etanercept is antibody against TNF alpha receptors.
Other potential targets for biologic agents include the cytokines IL-6, IL-1 and IL-7.
The B cells also on the biologic radar.
Because they are more specific agents, they have fewer side effects than DMARDs
Unfortunately, they are very expensive agents and one-year treatment course might cost up to 10 thousand dollars.
And don’t forget the elephants, the corticosteroids group.
It is old potent immunosuppressant group that have been used for treatment of rheumatoid arthritis for more than 70 years.
Unlike DMARDs the drugs of this group have similar chemical structure.
They have wide range of immunosuppressive and ant inflammatory effects
Which include
Inhibit arachidonic acid production
Cytokines inhibition
Inhibition of enzymes induction
Inhibition of T cell proliferation
Induction of apoptosis
They might be potent and cheap drugs but unfortunately, like an elephant in a china shop they have many notorious effects which include
Infection……. Peptic ulcer……. Osteoporosis……..Depression………Weight gain……glaucoma
Hyperglycaemia and Hypertension
Therefore, it would be better injected them intraarticularly to avoid systematic side effects
Finally and as usual me and Dr Jehad Hammad wish you happy reading.
The narration was read by Carla Tordoff-Gibson
Pharmacology and therapeutic department
Kings college London KCL university
