Volume: 2: Issue-1: Jan-Mar -2011

ISSN 0976-4550 Review Ar i!le

RHEUMATIOD ARTHRITIS: A REVIEW ARTICLE H.M.Asif1 *M. Akram2, Naveed Akhtar1, Khalil Ahmed1, S. M. Ali Shah1, Riaz ur Rehman1, E. Mohiuddin2, M. !rahim Khan2
1 2

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

INTRODUCTION
Rheumatoid arthritis is a disease of unkno(n aetiolo#& $hara$terized !& a $hroni$ )ol&arthritis in (hi$h the ma+or tar#et tissue is the s&novial linin# of the +oints, !ursa and tendons sheath resultin# in var&in# de#rees of +oint deformities and asso$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 several re)orts. Enhan$ed understandin# of mole$ular )atho#enesis has ena!led develo)ment of innovative !iolo#i$al a#ents that tar#et s)e$ifi$ )arts of the immune s&stem. -hese treatments have $han#ed the $ourse and fa$e of rheumatoid arthritis and out$omes for )atients and so$iet&. Ne( kno(led#e has emer#ed of ho( environmental fa$tors intera$t (ith sus$e)ti!ilit& #enes and the immune s&stem in the )atho#enesis of a ma+or su!set of rheumatoid arthritis .Klaresko# et al, 2//01. "onsidera!le advan$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#ress of rheumatoid arthritis has sho(n $onsidera!le develo)ment and validation for $lini$al trials and, $onse2uentl&, innovative trial desi#ns. n )arallel, !asi$ resear$h has )rovided $lues to the )atho#eni$ events underl&in# rheumatoid arthritis, and advan$es have fa$ilitated the develo)ment of ne( $lasses of thera)euti$s .3osef S et al, 2//41.

Epidemiology
-he in$iden$e of rheumatoid arthritis as re)orted in 1004 is /.2 )er 1/// )o)ulation for males and /.5 )er 1/// for females !ut virtual a!sen$e of e)idemiolo#i$ data of the under develo)ed or develo)in# $ountries of the (orld does not re)orted the true )i$ture thus e)idemiolo#i$al findin#s under s$ore the $om)le6it& of rheumati$ disease .Sherine E, 2//01

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 $ommon re)resentations are diffuse s&mmetri$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 terms su))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!al medi$ines.

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ISSN 0976-4550

-his arti$le des$ri!es the $urrentl& availa!le s$ientifi$ eviden$e that re#ardin# the safet& and effi$a$& and to6i$ effe$ts, if kno(n, of Apium graveolens, Nigella Sativa L., Smilax China, Trigonella foenum graecum L., Zingiber officinale, Withania somnifera dunal and Colchicum autumnale L. sin$e these are most $ommonl& used as medi$inal a#ents for the treatment of rheumatoid arthritis or the a$tion of these medi$ine is like(ise ,isease Modif&in# Anti Rheumati$ ,ru#s .,MAR,1. 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 for Eastern Medi$ine on the )atient livin# in the rural areas of 8/ villa#es surroundin# Madinat7 ul7Hikmah Hamdard %niversit&, Kara$hi. -he stud& (as $arried out from Se)tem!er 2//9 to Au#ust 2//:. -he )atients ;/ in num!er (ere treated (ith Arthritin and ;/ of Methotre6ate for t(ent& four (eeks !ased on randomized $lini$al trial. "hi7s2uare test and e6a$t fisher test (ere used to anal&ze the statisti$al differen$e. Arthritin and Methotre6ate (ere )res$ri!ed to 1// )atients (ith rheumatoid arthritis. -he )rimar& $riteria in evaluatin# the effi$a$& (as the de#ree of relief of )ain, s(ellin#, stiffness and tenderness ho( the )atients felt after takin# the medi$ation. After si6 months stud& of )atients takin# the her!al formulation orall&, three times )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& reveals that in $ase of rheumatoid arthritis (hen treated (ith Arthritin and Methotre6ate, the result on the effi$a$& dis)la& that Arthritin is more effe$tive for treatment of rheumatoid arthritis.<(ais M. et al 2/1/1.

An i'inflamma o"y coope"a i(i y of co" ico# e"oid# and no"epinep$"ine in "$e!ma oid a" $"i i# #yno(ial i##!e in (i(o and in (i "o
"orti$osteroids ."S1 and nore)ine)hrine .NE1 su))ort ea$h other=s !iolo#i$al effe$ts. -hus, defi$ien$& of $ortisol and redu$ed s&novial s&m)atheti$ innervation .SS 1 ma& !e )roinflammator& in rheumatoid arthritis .RA1. -his stud& tested the anti7 inflammator& $oo)erativit& of "S and NE in human RA s&novial tissue. n an in vivo stud&, 42 )atients (ith RA .(ith )rior "S thera)&>(ithout SS ? n@8A (ithout )rior "S thera)&>(ith SS ? 9A (ith )rior "S thera)&>(ith SS ? 101 (ere investi#ated for s&novial inflammation. n an in vitro stud& (ith s&novio$&tes from RA and <A )atients, the se)arate and $om!ined effe$ts of $ortisol and NE (ere studied. n the in vivo stud&, )atients (ith )rior "S thera)&>(ith SS sho(ed lo(er se$retion of s&novial B7: than the other #rou)s, lo(er s&novial densit& of $ells and ma$ro)ha#es, and lo(er overall inflammation. n the in vitro stud&, a $oo)erative su))ressive effe$t of NE .1/79 M to 1/7: M1 and $ortisol .1/79 M and 1/78 M1 on se$retion of B7: and -NC from )rimar& earl& $ulture mi6ed RA s&novio$&tes (as o!served. -his $oo)erative effe$t (as not o!served in <A s&novio$&tes. n the same RA and <A )atients, the $oo)erative effe$t (as lost in 4rd )assa#e s&novial fi!ro!lasts. -his stud& demonstrates the $oo)erativit& of $ortisol and NE for inhi!ition of )roinflammator& mediators )rodu$ed in the s&novial tissue of RA )atients. -hese results unders$ore that $ou)lin# of an effi$ient se$retion of s&stemi$ $ortisol to#ether (ith lo$al )rodu$tion of NE is im)ortant in order to lo(er s&novial inflammation .Strau! et al, 2//21.

T"ea men of R$e!ma oid A" $"i i# )i $ Me $o "e*a e Alone+ S!lfa#ala,ine and Hyd"o*yc$lo"o-!ine+ o" a Com.ina ion of All T$"ee Medica ion#
n this stud& 1/2 )atients (ere enrolled (ith rheumatoid arthritis and )oor res)onses to at least one disease7modif&in# dru# in a t(o7&ear, dou!le7!lind, randomized stud& of treatment (ith methotre6ate alone .8.; to 18.; m# )er (eek1, the $om!ination of sulfasalazine .;// m# t(i$e dail&1 and h&dro6&$hloro2uine .2// m# t(i$e dail&1, or all three dru#s. -he dose of methotre6ate (as ad+usted in an attem)t to a$hieve remission in all )atients. -he )rimar& end )oint of the stud& (as the su$$essful $om)letion of t(o &ears of treatment (ith ;/ )er$ent im)rovement in $om)osite s&m)toms of arthritis and no eviden$e of dru# to6i$it&.

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Cift& of the 1/2 )atients had ;/ )er$ent im)rovement at nine months and maintained at least that de#ree of im)rovement for t(o &ears (ithout eviden$e of ma+or dru# to6i$it&. Amon# them (ere 25 of 41 )atients treated (ith all three dru#s .88 )er$ent1, 12 of 49 )atients treated (ith methotre6ate alone .44 )er$ent, *D/.//1 for the $om)arison (ith the three7dru# #rou)1, and 15 of 4; )atients treated (ith sulfasalazine and h&dro6&$hloro2uine .5/ )er$ent, * @ /.//4 for the $om)arison (ith the threedru# #rou)1. Seven )atients in the methotre6ate #rou) and three )atients in ea$h of the other t(o #rou)s dis$ontinued treatment !e$ause of dru# to6i$it&. n )atients (ith rheumatoid arthritis, $om!ination thera)& (ith methotre6ate, sulfasalazine, and h&dro6&$hloro2uine is more effe$tive than either methotre6ate alone or a $om!ination of sulfasalazine and h&dro6&$hloro2uine.3ames R et al, 10091.

To al condyla" &nee "eplacemen in pa ien # )$o $a(e "$e!ma oid a" $"i i#/ A enyea" follo)'!p # !dy/
n this stud&, ei#ht& knee re)la$ements (ith a total $ond&lar )rosthesis in )atients (ho had rheumatoid arthritis (ere follo(ed for ten &ears. At ten &ears, nineteen knees needed revision and si6t&7one )rostheses (ere still fun$tionin#. -he ma+or reasons for revision (ere loosenin# 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 to mal)osition of the ti!ial $om)onent. A$$ordin# to the s&stem of -he Hos)ital for S)e$ial Sur#er&, the mean s$ores (ere 95 )oints )reo)erativel& and :; )oints )osto)erativel&. S&novitis re$urred in onl& 4 )er $ent of the knees. Ehen revision, )ain, or radio#ra)hi$ eviden$e of loosenin# (ere $onsidered an indi$ation of failure, the ten7&ear $umulative survival (as 8; )er $ent .Baskin RS, 100/1.

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 a multi$enter trial. -hose (ho res)onded to treatment then entered a dou!le7!lind stud& and (ere randoml& assi#ned to re$eive either )la$e!o or etaner$e)t for four months or until a flare of the disease o$$urred. A res)onse (as defined as an im)rovement of 4/ )er$ent or more in at least three of si6 indi$ators of disease a$tivit&, (ith no more than one indi$ator (orsenin# !& more than 4/ )er$ent. At the end of the o)en7la!el stud&, ;1 of the 90 )atients .85 )er$ent1 had res)onses to etaner$e)t treatment. n the dou!le7!lind stud&, 21 of the 29 )atients (ho re$eived )la$e!o .:1 )er$ent1 (ithdre( !e$ause of disease flare, as $om)ared (ith 8 of the 2; )atients (ho re$eived etaner$e)t .2: )er$ent1 .*@/.//41. -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/.//11. n the dou!le !lind stud&, there (ere no si#nifi$ant differen$es !et(een the t(o treatment #rou)s in the fre2uen$& of adverse events. t (as $on$luded that treatment (ith etaner$e)t leads to si#nifi$ant im)rovement in )atients (ith a$tive )ol&arti$ular +uvenile rheumatoid arthritis. Etaner$e)t is (ell tolerated !& )ediatri$ )atients.,aniel 3 et al, 2///1

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A/ram e al RE1ERENCES

ISSN 0976-4550

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