scholarly journals Painful Rheumatoid Arthritis

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. E427-E458
Author(s):  
Pya Seidner
Keyword(s):  
Rheumatoid Arthritis ◽  
Severe Pain ◽  
Interleukin 1 ◽  
Certolizumab Pegol ◽  
Key Words Rheumatoid Arthritis ◽  
Biologic Agents ◽  
Interdisciplinary Teams ◽  
Necrosis Factor Alpha ◽  
Clinical Indicators ◽  
The Past

Rheumatoid arthritis is a crippling disease that is often associated with severe pain, suffering, and diminished function, thereby detracting from an optimal quality of life. Over the past decade a greater appreciation of the pathophysiology of rheumatoid arthritis has been gained. In the past “decade of pain research,” biologic agents which may modify rheumatoid arthritis have emerged as potent therapeutic antirheumatic drugs. Biologic agents include 5 tumor necrosis factor alpha inhibitors (etanercept, infliximab, adalimumab, golimumab, certolizumab pegol), interleukin-1 blockers (anakinra), monocloncal antibodies against B cells (rituximab), T cell costimulation blocker (abatacept), and interleukin-6 inhibitors (tocilizumab). Currently, utilizing therapy aimed at targeting various abnormalities of rheumatoid arthritis may be possible. It appears that the combined use of etanercept and methotrexate may improve the imbalance of Th1/Th2 and Th17/regulatory T cells (Treg) (and related cytokines) often seen in rheumatoid arthritis. Furthermore, this improvement in Tcell ratios/cytokines is also associated with improvement in clinical indicators of rheumatoid arthritis severity. Although rheumatologists are generally the specialists “called on” to manage complex patients with rheumatoid arthritis, pain specialists may be asked to join interdisciplinary teams managing patients with advanced refractory rheumatoid arthritis with severe pain since one of the most common and debilitating symptoms of rheumatoid arthritis is pain. Thus, pain specialists should have some appreciation of the current thoughts regarding rheumatoid arthritis pathophysiology and treatment. This narrative review of rheumatoid arthritis is intended to familiarize the interventional pain specialist with current concepts surrounding rheumatoid arthritis. Key words: Rheumatoid Arthritis, Pain, DMARDs, biological agengs, TNF inhibitors

scholarly journals Biological Agents in the Treatment of Rheumatoid Arthritis

1970 ◽  
Vol 29 (1) ◽  
pp. 27-31
Author(s):  
SM Kamal ◽  
MA Bakar
Keyword(s):  
Rheumatoid Arthritis ◽  
Interleukin 1 ◽  
Cartilage Damage ◽  
Key Words Rheumatoid Arthritis ◽  
Biological Agents ◽  
Joint Disease ◽  
Onset Of Action ◽  
Necrosis Factor Alpha ◽  
Factor Alpha ◽  
Considerable Morbidity

Rheumatoid arthritis (RA) is the commonest joint disease with considerable morbidity and mortality. Conventional disease modifying antirheumatic drugs like methotrexate form the cornerstone of therapy. These drugs have several limitations in terms of slow onset of action, adverse effects and modest remission rates. Several cytokines are involved in the pathogenesis of RA. Biological agents that specifically inhibit the effects of tumour necrosis factor-alpha (TNF-a) or interleukin-1 (IL-1) represent a major advancement in the treatment of RA. By targeting mediators that are directly involved in the pathogenesis of RA, these agents slow the radiological progression of bone and cartilage damage in joints, prevent or delay the onset of disability. These are highly specific and better tolerated. The use of these biological agents needs careful monitoring for side effects, including the development of infection. Additional anti-cytokine agents for the treatment of RA are under further development. Key words: Rheumatoid arthritis; biological agents; inflammatory cytokine. DOI: 10.3329/jbsp.v29i1.7168J Bangladesh Coll Phys Surg 2011; 29:27-31

scholarly journals Comparison of Certolizumab Pegol with Other Anticytokine Agents for Treatment of Rheumatoid Arthritis: A Multiple-treatment Bayesian Metaanalysis

2011 ◽  
Vol 38 (5) ◽  
pp. 835-845 ◽  
Author(s):  
ROBERT LAUNOIS ◽  
BERNARD AVOUAC ◽  
FRANCIS BERENBAUM ◽  
OLIVIER BLIN ◽  
ISABELLE BRU ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interleukin 1 ◽  
Certolizumab Pegol ◽  
Inadequate Response ◽  
Acr20 Response ◽  
Multiple Treatment ◽  
American College Of Rheumatology ◽  
Significant Efficacy ◽  
Treatment Comparisons ◽  
Factor Α

Objective.To compare the clinical efficacy of certolizumab pegol (CZP) with that of other anticytokine agents indicated for the treatment of rheumatoid arthritis (RA) with identical therapeutic indication (anti-tumor necrosis factor-α, anti-interleukin 1 or 6), with the objective of determining the noninferiority of CZP.Methods.A systematic review was performed to identify randomized controlled trials that assessed the efficacy of anticytokine agents in combination with conventional disease-modifying antirheumatic drugs (DMARD) after 6 months of treatment, using the American College of Rheumatology (ACR) response criteria, in patients with RA who have shown inadequate response to DMARD including methotrexate. Indirect treatment comparisons were carried out by a multiple-treatment Bayesian random-effects metaanalysis. Data were analyzed using the Markov chain Monte Carlo simulation. Noninferiority of CZP was assessed in comparison with a predefined equivalence margin of 5%.Results.Nineteen placebo-controlled studies were identified: 14 evaluated the efficacy of 5 anti-TNF-α agents (infliximab, etanercept, adalimumab, golimumab, CZP) and 5 evaluated efficacy of 2 anti-interleukin agents (anakinra, tocilizumab). Every treatment showed significant efficacy versus placebo in individual studies. The multiple-treatment metaanalysis showed a highest OR for CZP on ACR20 response. Metaanalysis indicates that the efficacy of CZP according to ACR20 response is superior to that of infliximab, adalimumab, and anakinra, and equivalent or superior to that of etanercept, golimumab, and tocilizumab. According to ACR50 response, the efficacy of CZP is equivalent or superior to that of all other anticytokines.Conclusion.Results of this original multiple-treatment Bayesian metaanalysis indicate that certolizumab pegol is at least as efficacious as the preexisting antirheumatic anticytokine biotherapies.

scholarly journals Antcin K Inhibits TNF-α, IL-1β and IL-8 Expression in Synovial Fibroblasts and Ameliorates Cartilage Degradation: Implications for the Treatment of Rheumatoid Arthritis

2021 ◽  
Vol 12 ◽  
Author(s):  
David Achudhan ◽  
Shan-Chi Liu ◽  
Yen-You Lin ◽  
Chien-Chung Huang ◽  
Chun-Hao Tsai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cytokine Production ◽  
Bone Erosion ◽  
Interleukin 1 ◽  
Synovial Fibroblasts ◽  
Nuclear Factor Κb ◽  
Cartilage Degradation ◽  
Signaling Cascades ◽  
Necrosis Factor Alpha ◽  
Tnf Α

Extracts from Taiwan’s traditional medicinal mushroom, Antrodia cinnamomea, exhibit anti-inflammatory activities in cellular and preclinical studies. However, this paper is the first to report that Antcin K, a triterpenoid isolated from A. cinnamomea, inhibits proinflammatory cytokine production in human rheumatoid synovial fibroblasts (RASFs), which are major players in rheumatoid arthritis (RA) disease. In our analysis of the mechanism of action, Antcin K inhibited the expression of three cytokines (tumor necrosis factor alpha [TNF-α], interleukin 1 beta [IL-1β] and IL-8) in human RASFs; cytokines that are crucial to RA synovial inflammation. Notably, incubation of RASFs with Antcin K reduced the phosphorylation of the focal adhesion kinase (FAK), phosphoinositide 3-kinase (PI3K), protein kinase B (AKT) and nuclear factor-κB (NF-κB) signaling cascades, all of which promote cytokine production in RA. Intraperitoneal injections of Antcin K (10 mg/kg or 30 mg/kg) attenuated paw swelling, cartilage degradation and bone erosion, and decreased serum levels of TNF-α, IL-1β, IL-8 in collagen-induced arthritis (CIA) mice; in further experiments, IL-6 levels were similarly reduced. The inhibitory effects of Antcin K upon TNF-α, IL-1β and IL-8 expression in human RASFs was achieved through the downregulation of the FAK, PI3K, AKT and NF-κB signaling cascades. Our data support clinical investigations using Antcin K in RA disease.

scholarly journals Electrochemical Immunosensor for Simultaneous Determination of Emerging Autoimmune Disease Biomarkers in Human Serum

2021 ◽  
Vol 3 (1) ◽  
pp. 24
Author(s):  
Esther Sánchez-Tirado ◽  
Sara Guerrero ◽  
Araceli González-Cortés ◽  
Lourdes Agüí ◽  
Paloma Yáñez-Sedeño ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Human Serum ◽  
Simultaneous Determination ◽  
Inflammatory Cytokines ◽  
Interleukin 1 ◽  
Joint Destruction ◽  
Joint Damage ◽  
Necrosis Factor Alpha ◽  
Extracellular Matrix Components

Rheumatoid arthritis is an autoimmune disorder characterized by persistent erosive synovitis, systemic inflammation and the presence of autoantibodies, which play an important role in inducing inflammation and joint damage, releasing pro-inflammatory cytokines from monocytes and macrophages [1,2]. Likewise, neutrophil activating protein-2 (CXCL7) is a platelet-derived growth factor belonging to the CXC chemokine subfamily, which is expressed in serum, synovial fluid and synovial tissue of patients developing rheumatoid arthritis during the first twelve weeks, being useful to reflect local pathological changes [3]. Besides, matrix metalloproteinase-3 (MMP-3), which is induced by inflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α) in rheumatoid synovium, degrades several extracellular matrix components of cartilage and plays central roles in rheumatoid joint destruction [4]. Therefore, monitoring serum CXCL7 and MMP-3 levels is useful for predicting the disease activity in rheumatoid arthritis. In this work, the construction and analytical performance of a dual electrochemical platform for the simultaneous determination of CXCL7 and MMP-3 is described. After the optimization of experimental variables involved in the preparation and implementation of the biosensor, the analytical usefulness of the developed configuration was demonstrated by its application to the determination of these biomarkers in serum samples from healthy individuals and patients with rheumatoid arthritis. To carry out the simultaneous determination of CXCL7 and MMP3 in human serum, just a fifty-fold sample dilution in PBS of pH 7.4 was required. In addition, the results obtained using the dual immunosensor were compared with those provided by the respective ELISA immunoassays, yielding no significant differences between the two methods. It is important to highlight that reagents consumption, four times smaller using the dual immunosensor than that required in the ELISA protocol, and an assay time of 2 h 50 min versus almost 5 h, counted in both cases after incubation of the capture antibody, are advantageous features of the dual immunosensor [5].

Certolizumab-induced lichenoid eruption in a patient with rheumatoid arthritis

2021 ◽  
Vol 14 (12) ◽  
pp. e245875
Author(s):  
Anuj Kunadia ◽  
Kenneth Shulman ◽  
Naveed Sami
Keyword(s):  
Rheumatoid Arthritis ◽  
Drug Eruption ◽  
Certolizumab Pegol ◽  
Topical Steroids ◽  
Drug Induced ◽  
Necrosis Factor Alpha ◽  
Tnf Α ◽  
Upper And Lower Extremities ◽  
Factor Alpha ◽  
Lichenoid Eruption

Certolizumab is a monoclonal antibody against tumour necrosis factor-alpha (TNF-α) commonly used in rheumatologic conditions such as rheumatoid arthritis. Skin rashes are an uncommon side effect with few cases of lichenoid drug eruption reported in the literature. We describe a patient with rheumatoid arthritis who presented 6 weeks after initiating certolizumab pegol. Physical examination showed pink-to-violaceous papules on her upper and lower extremities. Biopsy confirmed a lichenoid drug eruption. The medication was discontinued and she was treated with topical steroids and a calcineurin inhibitor, with resolution of her lesions. Clinicians should be cognizant of such adverse reactions to TNF-α inhibitors and keep drug-induced lichenoid eruptions on the differential. Lichenoid eruptions induced by certolizumab pegol may affect the skin and/or mucous membranes. While most cases occur within weeks to months of starting therapy, eruptions may occur years after treatment initiation, underscoring the importance of a thorough review of medications.

scholarly journals Indirect Treatment Comparison of Abatacept with Methotrexate Versus Other Biologic Agents for Active Rheumatoid Arthritis Despite Methotrexate Therapy in the United Kingdom

2012 ◽  
Vol 39 (6) ◽  
pp. 1198-1206 ◽  
Author(s):  
PATRICIA GUYOT ◽  
PETER C. TAYLOR ◽  
ROBIN CHRISTENSEN ◽  
LOUISA PERICLEOUS ◽  
PIETER DROST ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
United Kingdom ◽  
Certolizumab Pegol ◽  
Health Assessment ◽  
Patient Characteristics ◽  
Biologic Agents ◽  
Inadequate Response ◽  
Treatment Comparison ◽  
Relative Risks ◽  
The United Kingdom

Objective.To compare the efficacy of abatacept and alternative biologic disease-modifying antirheumatic drugs (DMARD) in patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (MTX) in the United Kingdom.Methods.A systematic literature search identified 11 individual studies investigating the efficacy of abatacept, infliximab, adalimumab, etanercept, certolizumab pegol, and golimumab in adult patients with RA that did not respond to MTX. The clinical trials included in this analysis were similar in trial design, baseline patient characteristics, and background therapy (i.e., MTX). The key clinical endpoints of interest were the Health Assessment Questionnaire (HAQ) change from baseline (CFB) and the American College of Rheumatology (ACR) responses at 6 months (24–28 weeks). Results were analyzed using Bayesian network metaanalysis methods, and were expressed as differences in HAQ CFB and ACR20/50/70 relative risks, with 95% credible limits (CrL).Results.Analysis of HAQ CFB at 6 months showed that abatacept is more efficacious than placebo [mean difference in HAQ CFB: −0.30 (95% CrL −0.42; −0.16)] and comparable to all other biologic agents, in patients receiving MTX as background treatment. Abatacept is also expected to result in a higher proportion of ACR responders compared to placebo, with relative risks ranging from 1.90 (95% CrL 1.24; 2.57) for ACR20 to 3.72 (95% CrL 1.50; 10.52) for ACR70, and to result in comparable proportions of ACR responders as other biologic agents, at 6 months.Conclusion.Abatacept is expected to result in improvement in functional status comparable to other recommended biologic agents in patients with RA who are unresponsive to MTX in the UK.

scholarly journals High-quality cooperative research: studies that represent a triumph in the rheumatology community

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Teresa A. Simon
Keyword(s):  
Rheumatoid Arthritis ◽  
Biologic Agents ◽  
Real Word ◽  
Cooperative Research ◽  
High Quality ◽  
The Past ◽  
Informed Treatment ◽  
New Treatments ◽  
Important Evidence

Abstract Over the past 20 years, the rheumatoid arthritis (RA) treatment landscape has been continuously evolving. A range of novel biologic agents, different from the conventional therapies, became available. However, some understandable concerns, such as long-term safety, accompanied their development. Over the years in rheumatology research, I aimed to broaden the knowledge of the new treatments of RA through real-word research, which proved to be valuable in providing important evidence to clinicians and enabling them to make informed treatment decisions. Nevertheless, many unanswered questions remain—it will be interesting to see how the research progresses over the next 20 years.

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