Phytochemicals and Novel Nanotherapeutic Approaches in the Management of Rheumatic Diseases

Over 100 types of arthritis have been recognized in which the dominating forms are osteoarthritis and rheumatoid arthritis. Joint stiffness, pain, swelling, lowered range of motion of joints affected, redness around joints are the main complications of almost all types of arthritis. Medications like non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, and immunosuppressants are only used to control the symptoms of the disease but are not able to alleviate them properly. However, with the incorporation of disease-modifying antirheumatic drugs (DMARDs) as well as tumor necrosis factor inhibitors (TNFi) in treatment, there are now promising therapeutic options to select from for the management of rheumatoid diseases. Nanotherapeutic approach has enabled us to deliver the disease-modifying agents directly to the inflammation site, thus eschewing off-target and unwanted systemic effects. Therefore, it provides an opportunity to reconsider the therapeutic compounds that were considered too toxic to be administrated via oral or parenteral route.

Case Report on Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder that inhibits the body's immune system that induces inflammation in the injured areas of the body. It is commonly caused the joints of the palms, wrists, and knees. An inflaming rheumatoid arthritis joint contributes to joint tissue damage. This condition may cause chronic or long term discomfort, instability, and deformation. Symptoms include exhaustion, pain, and depression. If the patient does not undergo early diagnosis and care for symptoms, a series of symptoms can arise including Osteoporosis, rheumatoid nodules, dry eye and mouth, carpal tunnel syndrome Case Report: The female patient name is Yogita Shinde 65-year-old religion Hindu lived in the kandhali. She was admitted to AVBR Hospital with the chief complaint of pain in her shoulder and hands, joints pain, swelling on both the hands. She started taking ibuprofen 800 mg 3 times per day to relieve discomfort and rigidity. Three months earlier, as she was doing her job, she had pain on her right and left shoulders. She still started to feel very sleepy and short-tempered. Tab ibuprofen was not an effective very long time for pain. One morning, Yogita couldn't lift her arms without the intense pain of her back. She was conscious that it was time for help. She had spoken to her parents, and they advised her to see a physician. The primary healthcare practitioner (PHP), who tested and carried out a variety of blood test. Positive-rheumatoid factors, CCP antibiotics, higher ESR, and C-reactive protein were seen via the blood samples. These findings were communicated to Yogita and the Rheumatologist was directed at her PCP to see her as soon as possible. The primary health care practitioner inquired about the medical records of Yogita parents and grandparents, family conditions, medical and operative records of yogita, and details on their family and working lives. And after that, the physician started the treatment, after which Yogita feels better for some days. After a few weeks she having recurrent pain in her hand and foot, this is intolerable to her. And then she is admitted to AVBR Hospital on date 20th Sept 2020

AB0060 INCREASED AGE/AUTOIMMUNE-ASSOCIATED B CELLS IN RA AND CLINICAL IMPLICATIONS

Background:Age/Autoimmune-associated B cells (ABCs) are an emerging B cell subset that accumulate in aged and autoimmune-prone mice. Expansion of human ABCs has been observed in patients with autoimmune diseases like SLE and correlated with disease activity. However, it is less known whether ABCs contribute to the pathogenesis of RA.Objectives:The aim of this work was to explore the role of ABCs in RA.Methods:83 RA patients who met the 2010 ACR classification criteria for RA, 42 sex and age matched healthy control (HC), 35 Spondyloarthritis (SpA) and 31 Osteoarthritis (OA) patients were enrolled and blood samples were collected. The proportion of circulating ABCs was detected by flow cytometry and association with clinical and laboratory parameters were analyzed. Expression of characteristic proteins and inflammatory cytokines on ABCs were examined by quantitative real-time PCR.Results:The proportion of ABCs, defined as CD19+CD27-IgD-CD21-CD11c+, was significantly elevated in RA patients, compared with HC, SpA and OA patients. The frequency of ABCs was higher in patients with high disease activity (DAS28>3.2) compared with remission and low disease activity (DAS28<3.2). There was a positive correlation of ABCs with SJC, TJC, DAS28 whereas no association with RF and anti-CCP titer were observed. In addition, increased mRNA expression levels of T-bet, IL-21, MAF and IL-17 were noted on ABCs compared with CD19+CD27-CD11c- B cells.Conclusion:ABCs were expanded in RA patients and associated with active disease status. It might contribute to RA development by production of IL-17.References:[1]Cancro, M.P., Age-Associated B Cells. Annu Rev Immunol, 2020. 38(315-340).[2]F. Zhang, K. Wei, K. Slowikowski et al., Defining inflammatory cell states in rheumatoid arthritis joint synovial tissues by integrating single-cell transcriptomics and mass cytometry. Nat Immunol 2019, 20, 928-942.Disclosure of Interests:None declared

The Research of Knowledge about the Joint Protection for Persons with Rheumatoid Arthritis

Research background. According to the statistics, every fourth resident of Lithuania complains of rheumatic malaise. Rheumatoid arthritis is the most serious disorder of rheumatic diseases. Reduced joint flexibility, joint deformities, and the surrounding muscles atrophy is one of the worst effects of RA. They affect self-care, productivity and leisure activities of the persons. For these reasons it is crucial for the persons with rheumatoid arthritis to be aware of possible harmful and dangerous aspects of their e daily life activities as well as the necessity of self-dependence. The aim of the research was to evaluate the knowledge of persons with rheumatoid arthritis about the joint protection during the exacerbations and remissions of the disease. Methods. The research involved 30 Kaunas city “Arthritis” club members with rheumatoid arthritis. Average age of respondents was 69.9 ± 0.9 years. The study was supported by a questionnaire, which included 29 questions. In order to protect their privacy, the patients were interviewed anonymously. Results. The research results showed which joint protection principles were best know and worst by the patients with RA. The study provided data about the behaviours of respondents in daily life activities protecting their joints of disease exacerbation and remission. Conclusions. It became clear that patients with rheumatoid arthritis had little knowledge about the possible ways of substitution of the injured joints, work and relaxation regimens, preservation of energy, joint mobility and stability and the use of technical rehabilitation devices. Persons with rheumatoid arthritis often avoided various activities during the exacerbation of the disease as well as they did not take care of their joints during the remission of the disease.Keywords: rheumatoid arthritis, joint protection, occupational therapy.