[Daily practice using the guidelines for prevention and treatment of osteoporosis. The effects of anti-TNF therapy on bone and joint manifestations in rheumatoid arthritis].
Patients diagnosed as RA should be started with disease modifying anti-rheumatic drugs (DMARDs) as early as possible. Among the DMARDs, methotrexate (MTX) is considered the anchor drug and should be used first in patients as risk of developing persistent disease. The main goal of DMARDs treatment is to achieve remission and monitoring of disease activity and adverse events should guide decisions on choice and changes in treatment strategies. However, treatment of RA with DMARDs including MTX often fails to control disease activity and prevent structural damage in a some population of patients. Therefore, more effective treatment strategies are needed. Tumor necrosis factor-alpha (TNF-alpha) , a representative pro-inflammatory cytokine, plays a pivotal role in the pathological process of RA by mediating initiation to autoimmunity, lymphocyte accumulation and angiogenesis in the inflamed synovium, and joint destruction. Treatment of RA patients with TNF inhibitors have been efficacious for a) a prolonged improvement in disease activity and an induction to remission, b) inhibition of radiographic progression, when they are used in combination with MTX. Thus, the combined use of the TNF-inhibitor and MTX has brought about a paradigm shift in the treatment goal of RA. However, their small but definite risks of serious infections are also clear and their occurrence mandates that TNF-inhibitors should be supervised by physicians with experience in their use.
Soen
Satoshi
S
Kinki University School of Medicine, Nara Hospital, Department of Orthopaedic Surgery and Rheumatology.
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008727:Methotrexate / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate