What is rheumatoid arthritis and what are the traditional methods of treatment?
Rheumatoid arthritis is a chronic autoimmune condition that affects the joints in particular. It is characterized by persistent inflammation and progressive destruction of the joints. The disease mainly affects the small joints of the hands and feet, but it can also involve other joints. Common symptoms include pain, swelling, stiffness and reduced joint mobility.
Although the exact cause of rheumatoid arthritis is not known, the interaction between genetic and environmental factors is believed to play an important role in the development of the disease.
The treatment is complex and includes several approaches. There are several treatment methods currently available for rheumatoid arthritis, which can be divided into 2 categories: traditional methods and innovative therapies.
Traditional treatment methods for rheumatoid arthritis include taking nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
Corticosteroids may be used to control severe inflammation and acute symptoms.
Disease-modulating antirheumatic drugs (DMARDs) are also prescribed to slow disease progression and reduce symptoms and are considered first-line drugs, biologic therapies, and immunomodulators.
Physical therapy and occupational therapy may also be recommended to maintain mobility and improve function.
New drugs for rheumatoid arthritis
In recent years, multiple innovative new drugs have been approved and brought to market for the treatment of rheumatoid arthritis, as well as the introduction of tools for clinical monitoring of disease activity and impact, and an increased focus on patient-centered care. These drugs had a significant impact on patients’ quality of life and disease progression.
Among the most recently approved drugs are: tumor necrosis factor (TNF) inhibitorswhich represent the most important pro-inflammatory cytokines, these cytokines being responsible for numerous pathological processes, such as cartilage degradation, favoring the immune response, initiation and perpetuation of inflammation.
Examples of antiTNF inhibitors are: adalimumab, certolizumab, golimumab, infliximab, etanercept, and they work by blocking a protein involved in inflammatory processes.
Also, immune system modulator drugs, such as janus kinase (JAK) inhibitorssuch as tofacitinib, baricitinib, upadacitinib, were most recently approved and used successfully in the treatment of rheumatoid arthritis.
After the diagnosis of the disease, it is recommended initially treatment with methotrexate and glucocorticoidsand in case of insufficient response to this therapy, in patients with negative prognostic factors (presence of specific autoantibodies, high disease activity, early erosions or failure of two csDMARDs), it is considered initiation of biological therapyafter careful analysis of cardiovascular, infectious, thromboembolic risks.
If after the first biological treatment there is no decrease in the activity of the disease, it is recommended to change it to one of the same class or another class, taking into account the risks.
Biological and immunomodulatory therapies in rheumatoid arthritis
As for biological therapies, these are drugs that aim to block certain proteins or receptors involved in the inflammatory process of rheumatoid arthritis.
These drugs are produced using biotechnological technology and are designed to specifically intervene in inflammatory mechanisms.
An example of a biological therapy used in the treatment of rheumatoid arthritis is anti-TNF, which inhibits the activity of tumor necrosis factor and reduces inflammation. Other biological therapies such as interleukin-6 (IL-6) inhibitorssuch as tocilizumab and sarilumab, or interleukin-17 (IL-17) inhibitorshave also been used successfully in treating the disease.
Recent studies have shown effectiveness in reducing inflammation, improving symptoms, slowing disease progression, significantly improving functionality and shortening morning sickness. However, there have also been studies that took into account the risk of secondary events such as cardiovascular events (MACE), malignancies, allergic reactions, infections, and it should be taken into account that patients should be closely monitored by the attending physician and report any side effects or adverse reactions.
Upadacitinib, a 2nd generation jak kinase inhibitor, is one of the most recently approved biological therapies and can be used both alone and in combination with methotrexate. The most important study that evaluated the efficacy and safety of upadacitinib in patients with rheumatoid arthritis and inadequate response to initial therapies (methotrexate, leflunomide, sulfasalazine) is the Select Next study.
It should be noted that these new therapies can be administered in injectable or tablet form.
Alternative and complementary therapies in rheumatoid arthritis
Alternative and complementary therapies are often used as additional methods in the management of rheumatoid arthritis. These may include acupuncture, therapeutic massage, dietary supplements and herbal remedies.
The role of alternative therapies in the management of rheumatoid arthritis can be to reduce pain, improve mobility and promote the general well-being of patients. However, research into the effectiveness of these alternative therapies is still ongoing, and results are mixed.
Recent studies have shown that certain alternative therapies such as physiotherapy and therapeutic massage, may have significant benefits in relieving symptoms and improving the quality of life of patients with rheumatoid arthritis. However, it is important to always consult a doctor before starting any alternative therapy.
Lifestyle changes and nutrition for the patient with rheumatoid arthritis
In addition to drug treatments and alternative therapies, lifestyle changes and nutrition play an important role in the management of rheumatoid arthritis. Adopting a healthy lifestyle can help control symptoms and improve patients’ quality of life.
One of the key components of a healthy lifestyle in rheumatoid arthritis is regular physical exercise. Adequate physical activity can help maintain joint mobility, strengthen muscles and reduce pain.
Also, adopting a balanced and healthy diet can have a positive impact on the management of rheumatoid arthritis.
Some research suggests that a diet rich in fresh fruits and vegetables, fatty fish, nuts and seeds, and limiting processed foods and foods high in saturated fat can help reduce inflammation and improve symptoms.
Conclusion regarding the treatment of rheumatoid arthritis
In conclusion, the treatment of rheumatoid arthritis is complex, must be initiated as soon as possible from the moment of diagnosis and involves multiple approaches. In addition to traditional methods such as anti-inflammatory drugs and physical therapy, innovative new drugs and biological therapies have been developed that have shown efficacy in reducing inflammation and improving symptoms.
Alternative and complementary therapies, such as physiotherapy and therapeutic massage, can be used as additional methods to control symptoms and improve patients’ quality of life, but it is important to always consult a doctor before starting any alternative therapy.
So, early diagnosis and initiation of a correct treatment plan contribute to a better prognosis of the disease. A multidisciplinary approach should be considered, including traditional methods, new drugs, biological and immunomodulatory therapies, alternative and complementary therapies, as well as lifestyle and nutritional changes.
We encourage patients to talk with their doctor about new treatment options available and to consider lifestyle adaptations to support disease management.
Management should also include monitoring, pre-treatment investigations and vaccinations and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails.
Sources:
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Burmester GR, Kremer JM, Van den Bosch F, Kivitz A, Bessette L, Li Y, Zhou Y, Othman AA, Pangan AL, Camp HS. Safety and efficacy of upadacitinib in patients with rheumatoid arthritis and inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs (SELECT-NEXT): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2018 Jun 23;391(10139):2503-2512. two: 10.1016/S0140-6736(18)31115-2. Epub 2018 Jun 18. PMID: 29908669.
Kerschbaumer A, Sepriano A, Bergstra SA, Smolen JS, van der Heijde D, Caporali R, Edwards CJ, Verschueren P, de Souza S, Pope JE, Takeuchi T, Hyrich KL, Winthrop KL, Aletaha D, Stamm TA, Schoones JW, Landewé RBM. Efficacy of synthetic and biological DMARDs: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2023 Jan;82(1):95-106. doi:10.1136/ard-2022-223365. Epub 2022 Nov 11. PMID: 36368906.
Conley, B., Bunzli, S., Bullen, J. et al. What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines. Clin Rheumatol (2023).
2023-07-25 04:26:01
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