Via practica 2/2005

PHARMACOTHERAPEUTIC APPROACHES FOR RHEUMATOID ARTHRITIS

Rheumatoid Arthritis (RA) is a chronic inflammatory multisystemic disease, affecting mostly synovial joints. Polyarthritis syndrom most often symetrically affects peripheral joints of the hands and feet. It may affect also connective tissue of other systems (vessel, heart, lungs, eyes and other). Activity of the disease oscillates and eventuates in permanent deforming and destructive disability of the joints. Rheumatod arthritis shortens the life expectancy in women and men on the average of 10 years in comparison with normal population. The aim of therapy of RA is inducing the remission, or decreasing the activity of the process in the joints, slowing down the destruction of the affected joints, preventing formation of deformities and ankylosis. Non-steroid antiflogistics, basal drugs and glucocorticoids are used in the treatment. Non-steroid antiflogistics (NSA) are the drug of first choice in the treatment the arthritic syndrom in RA. They are a strategic mean of therapy, for reducing the pain, decreasing the symptoms of inflammation and optimalization of the quality of life of the patients until the basal drugs take their effect. Basal drugs in RA (DMARDs – disease modifying antirheumatic drugs), are a strategic instrument of the treatment, the effects of the drugs appear in weeks or months, depending on the type of the drug. The aim of the application of these drugs is to affect the imunopathogenetic processes in RA, decreasing the inflammatory activity in joints and slowing down, or inhibiting the progression of the disease. The choice of the right drug is in the hands of rheumathologist and depends on the actual condition of the patient. Biological therapy is used recently in resistent forms of RA, in those cases, where the basal treatment doesn`t show satisfactory results, as well as in early forms of RA with high activity, in order to decrease the activity of the process in joints and progression of the disease. Glucocorticoids are playing a very important role in the anti-inflammatory treatment of RA. Their use is usually time limited and they are a part of the combined treatment with non-steroid antiflogistics and basal antirheumatics.

Keywords: Rheumatoid arthritis, non-steroidal antirheumatics, non-steroidal antiinflammatory drugs, basal therapy – DMARDs, biological therapy, glucocorticoids.