15 rheumatoid arthritis

8/12/2019 15 Rheumatoid Arthritis

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Volume: 2: Issue-1: Jan-Mar -2011 ISSN 0976-4550 Review Ar i!le

RHEUMATIOD ARTHRITIS: A REVIEW ARTICLE

H.M.Asif 1 *M. Akram 2, Naveed Akhtar 1, Khalil Ahmed 1, S. M. Ali Shah 1, Riaz urRehman 1, E. Mohiuddin 2, M. !rahim Khan 2

1"olle#e of "onventional Medi$ine, slamia %niversit&, 'aha(al)ur, akistan2Shifa ul Mulk Memorial Hos)ital, Hamdard %niversit&, Kara$hi, akistan

INTRODUCTIONRheumatoid arthritis is a disease of unkno(n aetiolo#& $hara$terized !& a $hroni$

)ol&arthritis in (hi$h the ma+or tar#et tissue is the s&novial linin# of the +oints, !ursa andtendons sheath resultin# in var&in# de#rees of +oint deformities and asso$iated mus$le(astin#. es)ite rheumatoid arthritis is traditionall& $onsidered as a s&stemi$, inflammator&,autoimmune disorder !ut it differs from or#an s)e$ifi$ autoimmune disease entities in severalre)orts. Enhan$ed understandin# of mole$ular )atho#enesis has ena!led develo)ment ofinnovative !iolo#i$al a#ents that tar#et s)e$ifi$ )arts of the immune s&stem. -hese treatmentshave $han#ed the $ourse and fa$e of rheumatoid arthritis and out$omes for )atients andso$iet&. Ne( kno(led#e has emer#ed of ho( environmental fa$tors intera$t (ithsus$e)ti!ilit& #enes and the immune s&stem in the )atho#enesis of a ma+or su!set ofrheumatoid arthritis Klaresko# et al, 2//0 . "onsidera!le advan$es in re$ent &ears in !oth the$lini$al and !asi$ resear$h as)e$ts of rheumatoid arthritis have !een made. "lini$al )ro#ressof rheumatoid arthritis has sho(n $onsidera!le develo)ment and validation for $lini$al trials

and, $onse uentl&, innovative trial desi#ns. n )arallel, !asi$ resear$h has )rovided $lues tothe )atho#eni$ events underl&in# rheumatoid arthritis, and advan$es have fa$ilitated thedevelo)ment of ne( $lasses of thera)euti$s 3osef S et al, 2//4 .

Epidemiology-he in$iden$e of rheumatoid arthritis as re)orted in 1004 is /.2 )er 1/// )o)ulation for malesand /.5 )er 1/// for females !ut virtual a!sen$e of e)idemiolo#i$ data of the under develo)edor develo)in# $ountries of the (orld does not re)orted the true )i$ture thus e)idemiolo#i$alfindin#s under s$ore the $om)le6it& of rheumati$ disease Sherine E, 2//0

Clinical fea !"e#Rheumatoid arthritis is a hetero#eneous disease does not involve a sin#le entit&. -&)i$all&small +oints of the hands and feet as (ell as the (rists are affe$ted. 'ut more $ommonre)resentations are diffuse s&mmetri$al +oint )ain, s(ellin# and stiffness of small )eri)heral

+oints.

T"ea men-he mana#ement of rheumatoid arthritis is a multidis$i)linar& a))roa$h in order to lessen the

)ain, redu$tion of inflammation and restoration of +oints fun$tion. n )ra$ti$al termssu))ression of inflammation is the tar#et intensive thera)&. Her!al medi$ines have !e$ome

)o)ular for the treatment of rheumatoid arthritis (orld(ide re$entl&.

Re#ea"c$ S !dy on R$e!ma oid a" $"i i# in %a&i# an

"onsiderin# all the a!ove mentioned salient features the )ast de$ades has !rou#ht man& ne(insi#hts re#ardin# the treatment o)tions for the rheumati$ disease (ith allo)athi$ and her!almedi$ines. In erna ional Journal o" A##lie$ %iolo&' an$ ()arma!eu i!al *e!)nolo&' (a&e:10+

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A/ram e al ISSN 0976-4550

-his arti$le des$ri!es the $urrentl& availa!le s$ientifi$ eviden$e that re#ardin# the safet& andeffi$a$& and to6i$ effe$ts, if kno(n, of Apium graveolens, Nigella Sativa L., Smilax China,Trigonella foenum graecum L., Zingiber officinale , Withania somnifera dunal and Colchicumautumnale L . sin$e these are most $ommonl& used as medi$inal a#ents for the treatment ofrheumatoid arthritis or the a$tion of these medi$ine is like(ise isease Modif&in# AntiRheumati$ ru#s MAR . A stud& (as done to evaluate the effi$a$& of her!al medi$ine in$om)arison (ith allo)athi$ medi$ine methotr6ate for treatment of rheumatoid arthritis. -his$ase $ontrol e6amination !ased stud& (as $ondu$ted at Shifa7ul7Mulk Memorial Hos)ital forEastern Medi$ine on the )atient livin# in the rural areas of 8/ villa#es surroundin# Madinat7ul7Hikmah Hamdard %niversit&, Kara$hi. -he stud& (as $arried out from Se)tem!er 2//9 toAu#ust 2//:. -he )atients ;/ in num!er (ere treated (ith Arthritin and ;/ of Methotre6atefor t(ent& four (eeks !ased on randomized $lini$al trial. "hi7s uare test and e6a$t fisher test(ere used to anal&ze the statisti$al differen$e. Arthritin and Methotre6ate (ere )res$ri!ed to1// )atients (ith rheumatoid arthritis. -he )rimar& $riteria in evaluatin# the effi$a$& (as thede#ree of relief of )ain, s(ellin#, stiffness and tenderness ho( the )atients felt after takin#the medi$ation. After si6 months stud& of )atients takin# the her!al formulation orall&, threetimes )er da&, )atients re)orted im)roved ran#e of motion in their +oints and de$reased )ain,s(ellin#, tenderness, in hands el!o(s, knees, ankles +oints. -his stud& ver& $learl& revealsthat in $ase of rheumatoid arthritis (hen treated (ith Arthritin and Methotre6ate, the result onthe effi$a$& dis)la& that Arthritin is more effe$tive for treatment of rheumatoidarthritis


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Cift& of the 1/2 )atients had ;/ )er$ent im)rovement at nine months and maintained at leastthat de#ree of im)rovement for t(o &ears (ithout eviden$e of ma+or dru# to6i$it&. Amon#them (ere 25 of 41 )atients treated (ith all three dru#s 88 )er$ent , 12 of 49 )atients treated(ith methotre6ate alone 44 )er$ent, D/.//1 for the $om)arison (ith the three7dru# #rou) ,and 15 of 4; )atients treated (ith sulfasalazine and h&dro6&$hloro uine 5/ )er$ent, @/.//4 for the $om)arison (ith the threedru##rou) . Seven )atients in the methotre6ate #rou) and three )atients in ea$h of the other t(o#rou)s dis$ontinued treatment !e$ause of dru# to6i$it&. n )atients (ith rheumatoid arthritis,$om!ination thera)& (ith methotre6ate, sulfasalazine, and h&dro6&$hloro uine is moreeffe$tive than either methotre6ate alone or a $om!ination of sulfasalazine andh&dro6&$hloro uine 3ames R et al, 1009 .

To al condyla" &nee "eplacemen in pa ien # )$o $a(e "$e!ma oid a" $"i i#/ Aenyea" follo)'!p # !dy/

n this stud&, ei#ht& knee re)la$ements (ith a total $ond&lar )rosthesis in )atients (ho hadrheumatoid arthritis (ere follo(ed for ten &ears. At ten &ears, nineteen knees needed revisionand si6t&7one )rostheses (ere still fun$tionin#. -he ma+or reasons for revision (ereloosenin# of the ti!ial $om)onent or late !a$teremi$ seedin# from another site. Radiolu$en$&at the !one7$ement interfa$e ad+a$ent to the ti!ial $om)onent (as statisti$all& related tomal)osition of the ti!ial $om)onent. A$$ordin# to the s&stem of -he Hos)ital for S)e$ialSur#er&, the mean s$ores (ere 95 )oints )reo)erativel& and :; )oints )osto)erativel&.S&novitis re$urred in onl& 4 )er $ent of the knees. hen revision, )ain, or radio#ra)hi$eviden$e of loosenin# (ere $onsidered an indi$ation of failure, the ten7&ear $umulativesurvival (as 8; )er $ent Baskin RS, 100/ .

E ane"cep in C$ild"en )i $ %olya" ic!la" 0!(enile R$e!ma oid A" $"i i#n this stud& , atients 5 to 18 &ears old re$eived /.5 m# of etaner$e)t )er kilo#ram of !od&(ei#ht su!$utaneousl& t(i$e (eekl& for u) to three months in the initial, o)en7la!el )art of amulti$enter trial. -hose (ho res)onded to treatment then entered a dou!le7!lind stud& and(ere randoml& assi#ned to re$eive either )la$e!o or etaner$e)t for four months or until a flareof the disease o$$urred. A res)onse (as defined as an im)rovement of 4/ )er$ent or more inat least three of si6 indi$ators of disease a$tivit&, (ith no more than one indi$ator (orsenin#

!& more than 4/ )er$ent. At the end of the o)en7la!el stud&, ;1 of the 90 )atients 85 )er$enthad res)onses to etaner$e)t treatment. n the dou!le7!lind stud&, 21 of the 29 )atients (hore$eived )la$e!o :1 )er$ent (ithdre( !e$ause of disease flare, as $om)ared (ith 8 of the 2;

)atients (ho re$eived etaner$e)t 2: )er$ent @/.//4 . -he median time to disease flare(ith )la$e!o (as 2: da&s, as $om)ared (ith more than 119 da&s (ith etaner$e)t D/.//1 .n the dou!le !lind stud&, there (ere no si#nifi$ant differen$es !et(een the t(o treatment#rou)s in the fre uen$& of adverse events. t (as $on$luded that treatment (ith etaner$e)tleads to si#nifi$ant im)rovement in )atients (ith a$tive )ol&arti$ular +uvenile rheumatoidarthritis. Etaner$e)t is (ell tolerated !& )ediatri$ )atients aniel 3 et al, 2///

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RE1ERENCES

aniel 3, Bovell, Ed(ard H, Fiannini, Andreas R, Fail, "a(k(ell, Earl , Silverman, 3ames 3, No$ton, Beonard , Stein, A!raham F, Norman -, lo(ite, "arol A, alla$e, 3ames , 'ar!ara K,Cin$k, Etaner$e)t in "hildren (ith ol&arti$ular 3uvenile Rheumatoid Arthritis, N En#l 3 Med 2///452?8947890.

3ames R. ell, "laire E. Haire, RN, Nils E, alter , illiam , 3ames E, Gernon F, ierre M, B&nell, Klassen, Steven , Harr& K, Ferald C, Moore, -reatment of Rheumatoid Arthritis (ith

Methotre6ate Alone, Sulfasalazine and H&dro6&$hloro uine, or a "om!ination of All -hreeMedi$ations, N En#l 3 Med 1009 445?12:871201.

3osef S, F nter S, -hera)euti$ strate#ies for rheumatoid arthritis, Nature Revie(s ru# is$over&,2//4 2?58475::

Klaresko#, An$a, Ste)hen, rheumatoid arthritis, -he Ban$et, 2//0 484 0995 ?9;0 I 982

Baskin RS. -otal $ond&lar knee re)la$ement in )atients (ho have rheumatoid arthritis. A ten7&earfollo(7u) stud&, -he 3ournal of 'one and 3oint Sur#er&, 100/ 82 5 ?;207;4;

Muhammad

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