Pain, Inflammation, Joint disorders | April 13, 2015 | Author: The Super Pharmacist
Rheumatoid arthritis is a condition in which the protective cartilage within joints wears away (or degenerates) over time. This may proceed to a point at which the surfaces (or 'ends') of two bones that make up a joint are exposed rather than being coated with cartilage and results in increases in friction, decreases in normal motility and flexibility, and increased pain in the affected joint and is associated with significant reductions in functional status. Rheumatoid arthritis typically affects the hip joints and joints toward the periphery of the body, i.e. the fingers or knees and is also strongly associated with advancing age, with most cases diagnosed in people of 65 years or more.
Currently, there is no outright cure for the condition, with treatment focusing on reducing the mechanisms of cartilage loss, thus slowing or stopping the progression of the disease.
The symptoms of rheumatoid arthritis, mostly associated with this autoimmune and inflammatory activity, include:
Treatment for this condition may be established and conventional, novel, or variations on existing treatments. Due to the diversity of location, progression of the disease, age of the patient and effects on one's quality of life, treatment needs to be individualised.
This is a surgical technique reserved for severe and/or advanced cases of rheumatoid arthritis, most often applied to the hip or knee joint. It is the total or partial replacement of joint surfaces with medical prostheses or other products. Arthroplasty is a safe and effective treatment in many cases, but may be associated with adverse events such as the failure of integration of new implants or materials with the rest of the existing joint ('slippage' or 'loosening'). This may be associated with infection (e.g. 'septic slippage').
A trial compared a new technique of more extensive cementing of a knee prosthesis to the tibia, rather than surface cementing as is a conventional practice. The outcome measure (the lack of aseptic loosening at a ten-year follow-up) was shown to be 100% for the 'surface' group, compared to 93% in the full cementing group. Patient satisfaction was also significantly greater in the first group compared to the second.
These drugs reduce inflammation, and may therefore effectively alleviate symptoms including pain and redness in cases of rheumatoid arthritis.
These drugs can be administered orally to treat this condition. Corticosteroid injection therapies, in which the drugs are delivered directly into the joint via needle, are an increasingly common strategy. These are also known as intra-articular or joint injections. These injections, which may also include local anesthetics to numb damaged nerves, are effective and safe in most cases.
However, corticosteroids are associated with a range of side effects and adverse effects. These may include gastric ulceration and bleeding, hormonal changes resulting in metabolic, neurological or physiological changes, and immunosuppression. The risks of these adverse effects increase with the concentration and/or frequency of the doses of steroids administered. Other more rare events include the development of sepsis, necrosis or infections in the joint in question.
These are Disease-Modifying Anti-Rheumatic Drugs. DMARDs are divided into two main categories:
Conventional DMARDs include chemicals such as methotrexate. Some research indicates that approximately 33% of patients are resistant to treatment with conventional DMARDs. The main advantage of this therapy is cost, particularly compared to those of newer biologic DMARDs.
Biologic DMARDs may include drugs that bind to or inhibit molecules involved in the auto-immune response and/or inflammation. These molecules may include tumour necrosis factor-alpha (TNFalpha), a cytokine involved in the stimulation of inflammation. Drugs that inhibit this molecule may lead to improvement in cases of rheumatoid arthritis.
A review of trials investigating this strategy indicates that anti-TNFalpha therapy is associated with safety and some efficacy in patients aged both younger and older than 65 years. An analysis of data from over 1500 patients treated with anti-TNFalpha agents found that this therapy resulted in decreases in disease progression in patients both under and over 65 years, but in less functional improvement in the 'older' group compared with 'younger' group.
However, the inhibition of TNFalpha may lead to increased immune system suppression.
The co-administration of TNFalpha antagonists and corticosteroids may be associated with significant increases in the risk of infections in older patients.
An analysis of the incidence of infections in 341 patients found that the combination of anti-TNFalpha agents and other DMARDs doubled this risk, and the combination of corticosteroids with both treatments increased the risk of infection by 2.5 times.
The combination of TNFalpha with corticosteroids tripled the risk of infection. However, the risk of infection with any drug may be influenced by other factors, which include the severity of arthritis, and female gender.
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