DMARDs, Biologic Agents and Novel Experimental Strategies in The Treatment of Rheumatoid Arthritis

Year : 2024 | Volume :01 | Issue : 01 | Page : 14-24
By

Sagrika Kukade

Shilpa S. Borkar

Pankaj Dhapake

Jagdish R. Baheti

  1. Student,Department of pharmaceutics Kamla Nehru College of Pharmacy, Borkhedi gate, Butibori Nagpur Maharashtra India
  2. Professor, Department of Pharmacology Kamla Nehru College of Pharmacy, Borkhedi gate, Butibori Nagpur Maharashtra India
  3. Professor, Department of Pharmaceutics Kamla Nehru College of Pharmacy, Borkhedi gate, Butibori Nagpur Maharashtra India
  4. Principal, Department of Pharmacognosy Kamla Nehru College of Pharmacy, Borkhedi gate, Butibori Nagpur Maharashtra India

Abstract

Rheumatoid arthritis (RA) is an inflammatory and autoimmune illness that causes tremendous pain and swelling in the body’s affected regions. As per the study there is no known cure for the treatment of RA. Therefore, reducing discomfort and halting future harm must be the goals of present therapy. For the purpose of prevention and to reduce disease activity in RA patients, significant success has been achieved with the continued development of disease-modifying antirheumatic drugs (DMARDs). The inflammatory synovial joints that characterise rheumatoid arthritis (RA), a chronic autoimmune illness, cause joint degradation, incapacity, and a reduction in quality of life. Treatment for RA has advanced significantly over the years, especially with the advent of biologic medicines, disease-modifying anti-rheumatic medications (DMARDs), and creative experimental approaches. Unfortunately, some patients continue to respond poorly to DMARDs, thus it is necessary to develop new targets and treatments in treatment of RA. The foundation of RA treatment is the use of DMARDs, with methotrexate being the most effective option. Due to their ability to specifically target immune system components implicated in the pathophysiology of RA, biologic medicines have completely changed the way that the illness is managed. Clinical outcomes and disease activity have been demonstrated to be significantly improved by tumour necrosis factor (TNF) inhibitors, such as adalimumab and etanercept. The therapy arsenal has also been augmented by additional biologics that target B cells, T cells, and interleukin-6 (IL-6), giving patients who are not responsive to or tolerate traditional therapies more options. These medications delay the progression of illness and maintain joint function by lowering inflammation and inhibiting the immune system. But some patients may not react well to conventional DMARDs, thus other treatment alternatives must be investigated. Finding potential therapeutic targets and methods could be made easier by comprehending the pathogenetic roles played by the various molecules in RA. With a focus on the mechanisms that cause inflammation and the creation of new drugs for blocking the various modulators in RA, this review discusses both existing and emerging targets, including proteins.

Keywords: Rheumatoid arthritis, Treatment, DMARDs, Novel Strategies, Protein Targets.

[This article belongs to Emerging Trends in Personalized Medicines(etpm)]

How to cite this article: Sagrika Kukade, Shilpa S. Borkar, Pankaj Dhapake, Jagdish R. Baheti. DMARDs, Biologic Agents and Novel Experimental Strategies in The Treatment of Rheumatoid Arthritis. Emerging Trends in Personalized Medicines. 2024; 01(01):14-24.
How to cite this URL: Sagrika Kukade, Shilpa S. Borkar, Pankaj Dhapake, Jagdish R. Baheti. DMARDs, Biologic Agents and Novel Experimental Strategies in The Treatment of Rheumatoid Arthritis. Emerging Trends in Personalized Medicines. 2024; 01(01):14-24. Available from: https://journals.stmjournals.com/etpm/article=2024/view=134186

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References

  1. Kola-Mustapha AT, Khalid-Salako FA. Herbal emulgels incorporated with Cola millenii K. Schum stem bark ethanol extract potentially for the management of rheumatoid arthritis in-vitro. Phytomedicine plus. 2021 May 1;1(2):100033.
  2. Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone research. 2018 Apr 27;6(1):1-4.
  3. Sokka T, Abelson B, Pincus T. Mortality in rheumatoid arthritis: 2008 update. Clin Exp Rheumatol. 2008 Sep 1;26(5 Suppl 51): S35-61.
  4. Janke K, Biester K, Krause D, Richter B, Schürmann C, Hirsch K, Hörn H, Kerekes MF, Kohlepp P, Wieseler B. Comparative effectiveness of biological medicines in rheumatoid arthritis: systematic review and network meta-analysis including aggregate results from reanalysed individual patient data. bmj. 2020 Jul 7;370.
  5. Ahlmén M, Nordenskiold U, Archenholtz B, Thyberg I, Ronnqvist R, Lindén L, Andersson AK, Mannerkorpi K. Rheumatology outcomes: the patient’s perspective. A multicentre focus group interview study of Swedish rheumatoid arthritis patients. Rheumatology. 2005 Jan 1;44(1):105-10.
  6. Young A, Dixey J, Cox N, Davies P, Devlin J, Emery P, Gallivan S, Gough A, James D, Prouse P, Williams P. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow‐up in 732 patients from the Early RA Study (ERAS). Rheumatology. 2000 Jun 1;39(6):603-11.
  7. Kirwan JR, Minnock P, Adebajo A, Bresnihan B, Choy E, De Wit M, Hazes M, Richards P, Saag K, Suarez-Almazor M, Wells G. Patient perspective: fatigue as a recommended patient centered outcome measure in rheumatoid arthritis. The Journal of rheumatology. 2007 May 1;34(5):1174-7.
  8. Sanderson T, Morris M, Calnan M, Richards P, Hewlett S. What outcomes from pharmacologic treatments are important to people with rheumatoid arthritis? Creating the basis of a patient core set. Arthritis care & research. 2010 May;62(5):640-6.
  9. Srirangan S, Choy EH. The role of interleukin 6 in the pathophysiology of rheumatoid arthritis. Therapeutic advances in musculoskeletal disease. 2010 Oct;2(5):247-56.
  10. Kelley WN, Harris ED, Ruddy S, Sledge CB. Textbook of rheumatology. Philadelphia: Saunders; 1997.
  11. Bullock J, Rizvi SA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. Rheumatoid arthritis: a brief overview of the treatment. Medical Principles and Practice. 2019 Mar 1;27(6):501-7.
  12. Hewlett S, Chalder T, Choy E, Cramp F, Davis B, Dures E, Nicholls C, Kirwan J. Fatigue in rheumatoid arthritis: time for a conceptual model. Rheumatology. 2011 Jun 1;50(6):1004-6.
  13. Louati K, Berenbaum F. Fatigue in chronic inflammation-a link to pain pathways. Arthritis research & therapy. 2015 Dec;17(1):1-0.
  14. Matcham F, Ali S, Hotopf M, Chalder T. Psychological correlates of fatigue in rheumatoid arthritis: a systematic review. Clinical psychology review. 2015 Jul 1; 39:16-29.
  15. Katz P. Causes and consequences of fatigue in rheumatoid arthritis. Current opinion in rheumatology. 2017 May 1;29(3):269-76.
  16. Littlejohn EA, Monrad SU. Early diagnosis and treatment of rheumatoid arthritis. Primary Care: Clinics in Office Practice. 2018 Jun 1;45(2):237-55.
  17. Zhang Y, Gao Z, Chao S, Lu W, Zhang P. Transdermal delivery of inflammatory factors regulated drugs for rheumatoid arthritis. Drug Delivery. 2022 Dec 31;29(1):1934-50.
  18. Brzustewicz E, Bryl E. The role of cytokines in the pathogenesis of rheumatoid arthritis–Practical and potential application of cytokines as biomarkers and targets of personalized therapy. Cytokine. 2015 Dec 1;76(2):527-36.
  19. McInnes IB, Schett G. Pathogenetic insights from the treatment of rheumatoid arthritis. The Lancet. 2017 Jun 10;389(10086):2328-37.
  20. Gorantla S, Batra U, Samshritha RN, Puppala ER, Waghule T, Naidu VG, Singhvi G. Emerging trends in microneedle-based drug delivery strategies for the treatment of rheumatoid arthritis. Expert Opinion on Drug Delivery. 2022 Apr 3;19(4):395-407.
  21. Petrovská N, Prajzlerová K, Vencovský J, Šenolt L, Filková M. The pre-clinical phase of rheumatoid arthritis: from risk factors to prevention of arthritis. Autoimmunity Reviews. 2021 May 1;20(5):102797.
  22. Kgoebane K, Ally MM, Duim-Beytell MC, Suleman FE. The role of imaging in rheumatoid arthritis. SA Journal of Radiology. 2018 Jan 1;22(1):1-6.
  23. Warrington R, Watson W, Kim HL, Antonetti FR. An introduction to immunology and immunopathology. Allergy, Asthma & Clinical Immunology. 2011 Dec;7(1):1-8.
  24. Majithia V, Geraci SA. Rheumatoid arthritis: diagnosis and management. The American journal of medicine. 2007 Nov 1;120(11):936-9.
  25. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis & Rheumatism. 2002 Feb;46(2):328-46.
  26. Kwoh CK, Anderson LG, Greene JM, Johnson DA, O’Dell JR, Robbins ML, Roberts WN, Simms RW, Yood RA. Guidelines for the management of rheumatoid arthritis: 2002 update-American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Arthritis and Rheumatism. 2002;46(2):328-46.
  27. Staheli LT, Hall JG, Jaffe KM, Paholke DO, editors. Arthrogryposis: a text atlas. Cambridge university press; 1998 Apr 28.
  28. Ong CK, Lirk P, Tan CH, Seymour RA. An evidence-based update on nonsteroidal anti-inflammatory drugs. Clinical medicine & research. 2007 Mar 1;5(1):19-34.
  29. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circulation research. 2015 Mar 27;116(7):1254-68.
  30. Whittle SL, Colebatch AN, Buchbinder R, Edwards CJ, Adams K, Englbrecht M, Hazlewood G, Marks JL, Radner H, Ramiro S, Richards BL. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative. Rheumatology. 2012 Aug 1;51(8):1416-25.
  31. Richards BL, Whittle SL, van der HEIJDE DM, Buchbinder R. The efficacy and safety of antidepressants in inflammatory arthritis: a Cochrane systematic review. The Journal of Rheumatology Supplement. 2012 Sep 1;90:21-7.
  32. Smolen JS, Landewé R, Breedveld FC, Buch M, Burmester G, Dougados M, Emery P, Gaujoux-Viala C, Gossec L, Nam J, Ramiro S. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the rheumatic diseases. 2014 Mar 1;73(3):492-509.
  33. Tian H, Cronstein BN. Understanding the mechanisms of action of methotrexate. Bull NYU Hosp Jt Dis. 2007 Oct 1;65(3):168-73.
  34. Louie GH, Ward MM. Changes in the rates of joint surgery among patients with rheumatoid arthritis in California, 1983–2007. Annals of the rheumatic diseases. 2010 May 1;69(5):868-71.
  35. Chung KC, Pushman AG. Current concepts in the management of the rheumatoid hand. The Journal of hand surgery. 2011 Apr 1;36(4):736-47.
  36. Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. The Lancet. 2017 Jun 10;389(10086):2338-48.
  37. Fries JF. Current treatment paradigms in rheumatoid arthritis. Rheumatology. 2000 Jun 1;39(suppl_1):30-5.
  38. Lin YJ, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells. 2020 Apr 3;9(4):880.
  39. Brune K, Patrignani P. New insights into the use of currently available non-steroidal anti-inflammatory drugs. Journal of pain research. 2015;8:105.
  40. Crofford LJ. Use of NSAIDs in treating patients with arthritis. Arthritis research & therapy. 2013 Jul;15(3):1-0.
  41. van Everdingen AA, Jacobs JW, Siewertsz van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Annals of internal medicine. 2002 Jan 1;136(1):1-2.
  42. Silverstein FE, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, Makuch R, Eisen G, Agrawal NM, Stenson WF, Burr AM. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Jama. 2000 Sep 13;284(10):1247-55.
  43. Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: a review. Jama. 2018 Oct 2;320(13):1360-72.

Regular Issue Subscription Review Article
Volume 01
Issue 01
Received January 29, 2024
Accepted March 5, 2024
Published Mar 10, 2024