Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies

Due to the complex etiology of rheumatoid arthritis (RA), it is difficult to be completely cured at the current stage although many approaches have been applied in clinics, especially the wide application of nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). New drug discovery and development via the recently discovered cholinergic anti-inflammatory and antinociceptive pathways should be promising. Based on the above, the nicotinic acetylcholine receptor agonists maintain the potential for the treatment of RA. Therefore, new therapeutic approaches may rise from these two newly discovered pathways. More preclinical experiments and clinical trials are required to confirm our viewpoint.

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Nonsteroidal Anti-inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, and Agents Used in Gout

Handbook of Drug Interactions ◽

10.1007/978-1-61779-222-9_11 ◽

2011 ◽

pp. 415-475

Author(s):

Imad K. Abukhalaf ◽

Daniel A. von Deutsch ◽

Naser A. Ansari ◽

Asma Alsharif

Keyword(s):

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Anti Inflammatory

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Medical treatment of rheumatoid arthritis (I): Nonsteroidal anti-inflammatory drugs, disease modifying antirheumatic drugs and glucocorticoids

Journal of Korean Medical Association ◽

10.5124/jkma.2010.53.10.871 ◽

2010 ◽

Vol 53 (10) ◽

pp. 871 ◽

Cited By ~ 1

Author(s):

Eun-Mi Koh

Keyword(s):

Rheumatoid Arthritis ◽

Medical Treatment ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Anti Inflammatory

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Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

Clinical Rheumatology ◽

10.1007/s10067-020-05432-6 ◽

2020 ◽

Author(s):

Jorge Enrique Machado-Alba ◽

Manuel E. Machado-Duque ◽

Andres Gaviria-Mendoza ◽

Juan Manuel Reyes ◽

Natalia Castaño Gamboa

Keyword(s):

Rheumatoid Arthritis ◽

Pharmacological Treatment ◽

Healthcare Costs ◽

Cost Of Care ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Healthcare Resources ◽

Conventional Dmards ◽

Disease Modifying

Abstract Introduction/objectives The objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib. Method This is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider. Results We evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4–17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377. Conclusions In the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs. Key Points• Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs.• The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission.• Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.

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Cutaneous Polyarteritis Nodosa in Childhood: A Case Report and Review of the Literature

Arthritis ◽

10.1155/2010/687547 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Nina-Karen Bansal ◽

Kristin Michelle Houghton

Keyword(s):

Polyarteritis Nodosa ◽

Peripheral Nerves ◽

Biologic Therapy ◽

Musculoskeletal Symptoms ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Cutaneous Polyarteritis Nodosa ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Symptom Recurrence

Polyarteritis nodosa is a rare vasculitis of childhood. Cutaneous PAN (cPAN) is limited to the skin, muscles, joints, and peripheral nerves. We describe a 7.5-year-old girl with cPAN presenting initially as massive cervical edema who later went on to develop subcutaneous nodules, livedo reticularis, myositis, arthritis, and mononeuritis multiplex. The use of corticosteroids resulted in initial clinical improvement, but symptom recurrence necessitated disease modifying antirheumatic drugs and biologic therapy. We review a further 119 reports of biopsy proven cPAN in the literature. A majority of patients (96.6%) had cutaneous involvement; musculoskeletal involvement was common and included both articular (58.0%) and muscular (42.9%) symptoms, and nervous system involvement was least common (18.5%). Corticosteroids were used in the majority of patients (85.7%), followed by use of disease modifying antirheumatic drugs (33.0%), nonsteroidal anti-inflammatory drugs (10.7%), and intravenous immunoglobulin (9.8%). Therapy of cPAN with biologics has only been reported in 2 patients, and we report the first patient treated with Rituximab. A diagnosis of cPAN should be considered in a child with fever, vasculitic rash, and musculoskeletal symptoms. Most children respond to corticosteroids and have a benign course, but some require disease modifying antirheumatic drugs and biologic therapies.

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Efficacy of Anti-TNF Agents as Adjunctive Therapy for Knee Synovitis Refractory to Disease-Modifying Antirheumatic Drugs in Patients with Peripheral Spondyloarthritis

ISRN Rheumatology ◽

10.1155/2013/907085 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Grigorios T. Sakellariou ◽

Athanasios D. Anastasilakis ◽

Ilias Bisbinas ◽

Anastasios Gketsos ◽

Charalampos Berberidis

Keyword(s):

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Range Of Movement ◽

Dmard Therapy ◽

Disease Subtype ◽

Oral Corticosteroids ◽

Dose Oral ◽

Inflammatory Drugs ◽

Disease Modifying ◽

Peripheral Spondyloarthritis

Our aim was to evaluate the effectiveness of tumour necrosis factor (TNF) inhibitors as add-on therapy for knee synovitis that did not respond to disease-modifying antirheumatic drugs (DMARDs) and other standard treatments in patients with peripheral spondyloarthritis (SpA). We retrospectively studied 27 SpA patients, in whom an anti-TNF agent was added for active peripheral arthritis with knee synovitis refractory to DMARDs and treatment with low-dose oral corticosteroids and/or nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) corticosteroids. As response of knee synovitis, were considered the absence of swelling, tenderness, and decreased range of movement in the clinical examination, after 4 months of anti-TNF therapy. In twenty-four (88.9%) of the patients there was response of knee synovitis. No statistical differences in gender (P=0.53), age (P=0.88), disease subtype (P=0.22), and pattern of arthritis (P=0.20) between knee synovitis responders and nonresponders were found. Fourteen patients managed to stop DMARD therapy and six, all of whom were initially on DMARDs combination, to decrease the number of DMARDs to one, maintaining simultaneously the response of knee synovitis. Our results imply a beneficial effect of adjunctive anti-TNF therapy on knee synovitis not responding to DMARDs and other standard treatments in patients with peripheral SpA.

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Host Modulation and Treatment of Periodontal Disease

Journal of Dental Research ◽

10.1177/0022034521995157 ◽

2021 ◽

pp. 002203452199515

Author(s):

M.G. Balta ◽

E. Papathanasiou ◽

I.J. Blix ◽

T.E. Van Dyke

Keyword(s):

Clinical Trials ◽

T Regulatory Cells ◽

Inflammatory Diseases ◽

Periodontal Therapy ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Periodontal Inflammation ◽

Need To Evaluate ◽

Disease Modifying ◽

Anti Inflammatory

Periodontitis is the sixth-most prevalent disease in the world and the first cause for tooth loss in adults. With focus shifted to the inflammatory/immune response in the pathogenesis of periodontitis, there is a critical need to evaluate host modulatory agents. Synthetic and biological disease-modifying antirheumatic drugs are a cornerstone for the treatment of inflammatory diseases. Recent prospective cohort studies showed that synthetic disease-modifying antirheumatic drugs improved periodontal clinical parameters following nonsurgical periodontal treatment in patients with rheumatoid arthritis. Treatment with recombinant humanized monoclonal antibodies against CD20 (rituximab) and IL-6 receptor (tocilizumab), the latter also in clinical trials for the treatment of COVID-19 pneumonia, resulted in decreased periodontal inflammation and improved periodontal status. Studies on the effect of TNF-α inhibitors in patients with periodontitis yielded inconsistent results. Recent data suggest that probiotics provide anti-inflammatory clinical benefit, as do nutritional supplements, such as n-3 fatty acids, when combined with periodontal therapy. Probiotics reduce the production of proinflammatory cytokines/chemokines by suppressing NF-κB pathways and promote the accumulation of T regulatory cells. Statins, like aspirin, have been shown to exhibit anti-inflammatory and bone-preserving actions by upregulating production of Specialized Proresolving Mediators (SPMs). Currently, there is insufficient scientific support for the topical delivery of statins or bisphosphonates as adjuncts to periodontal therapy. Here, we present a critical review of the most recent host modulatory agents applied in humans and the key immune pathways that they target. Emerging evidence from novel drug candidates, including SPMs and complement inhibitors as previously studied in animal models and currently in human clinical trials, suggests future availability of adjunctive therapeutic strategies for the management of periodontitis.

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Current Therapy of Rheumatoid Arthritis (part 2)

Oceana Biomedicina Journal ◽

10.30649/obj.v1i2.14 ◽

2018 ◽

Vol 1 (2) ◽

pp. 90

Author(s):

Hendrata Erry Andisari

Keyword(s):

Tumor Necrosis ◽

Biological Agents ◽

Current Therapy ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Conventional Dmards ◽

Inflammatory Drugs ◽

Disease Modifying ◽

And Control ◽

Necrosis Factor

Therapy in RA has undergone many advances today and in line with knowledge of the pathogenesis of RA, the current therapeutic goal is to alter the journey and control the activity of RA disease. Several groups of drugs have been used in RA therapy including non-steroidal anti-inflammatory drugs (NSAIDs), conventional disease-modifying antirheumatic drugs (DMARDs) as well as biological agents (bDMARD), glucocorticoids and anti-pain medicines. In recent years, the development of biological agents that have specific targets for inflammatory mediators such as interleukin (IL) -1, IL-6 and Tumor Necrosis Factor (TNF) suggests a potent therapeutic effect on RA. In this article will be presented the latest biological agents as the latest therapy on RA. Keywords : conventional DMARDs, biological agents

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Application of Liposomes in Treatment of Rheumatoid Arthritis: Quo Vadis

The Scientific World JOURNAL ◽

10.1155/2014/978351 ◽

2014 ◽

Vol 2014 ◽

pp. 1-17 ◽

Cited By ~ 33

Author(s):

Bhupinder Kapoor ◽

Sachin Kumar Singh ◽

Monica Gulati ◽

Reena Gupta ◽

Yogyata Vaidya

Keyword(s):

Rheumatoid Arthritis ◽

Synovial Cells ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Emerging Trends ◽

Inflammatory Drugs ◽

Delivery Strategies ◽

Disease Modifying ◽

Quo Vadis ◽

Drug Free

The most common treatments for rheumatoid arthritis include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease modifying antirheumatic drugs (DMARDs), and some biological agents. However, none of the treatments available is able to achieve the ultimate goal of treatment, that is, drug-free remission. This limitation has shifted the focus of treatment to delivery strategies with an ability to deliver the drugs into the synovial cavity in the proper dosage while mitigating side effects to other tissues. A number of approaches like microemulsions, microspheres, liposomes, microballoons, cocrystals, nanoemulsions, dendrimers, microsponges, and so forth, have been used for intrasynovial delivery of these drugs. Amongst these, liposomes have proven to be very effective for retaining the drug in the synovial cavity by virtue of their size and chemical composition. The fast clearance of intra-synovially administered drugs can be overcome by use of liposomes leading to increased uptake of drugs by the target synovial cells, which in turn reduces the exposure of nontarget sites and eliminates most of the undesirable effects associated with therapy. This review focuses on the use of liposomes in treatment of rheumatoid arthritis and summarizes data relating to the liposome formulations of various drugs. It also discusses emerging trends of this promising technology.

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Recent Therapeutics Policies of Arthritis Rheumatoid (part I)

Oceana Biomedicina Journal ◽

10.30649/obj.v1i1.2 ◽

2018 ◽

Vol 1 (1) ◽

pp. 12

Author(s):

Hendrata Erry Andisari

Keyword(s):

Tumor Necrosis Factor ◽

Tumor Necrosis ◽

Biological Agents ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Inflammatory Drugs ◽

Disease Modifying ◽

And Control ◽

Necrosis Factor ◽

Arthritis Rheumatoid

Therapy in RA has undergone many advances today and in line with knowledge of the pathogenesis of RA, the current therapeutic goal is to alter the journey and control the activity of RA disease. Several groups of drugs have been used in RA therapy including non-steroidal anti-inflammatory drugs (NSAIDs), conventional disease-modifying antirheumatic drugs (DMARDs) as well as biological agents (bDMARD), glucocorticoids and anti-pain medicines. In recent years, the development of biological agents that have specific targets for inflammatory mediators such as interleukin (IL) -1, IL-6 and Tumor Necrosis Factor (TNF) suggests a potent therapeutic effect on RA. In this article will be presented the latest biological agents as the latest therapy on RA.

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