MANAGEMENT OF OSTEOARTHRITIS AND RHEUMATOID-ARTHRITIS - PROSPECTS ANDPOSSIBILITIES

Authors
Citation
Wd. Blackburn, MANAGEMENT OF OSTEOARTHRITIS AND RHEUMATOID-ARTHRITIS - PROSPECTS ANDPOSSIBILITIES, The American journal of medicine, 100, 1996, pp. 24-30
Citations number
47
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00029343
Volume
100
Year of publication
1996
Supplement
2A
Pages
24 - 30
Database
ISI
SICI code
0002-9343(1996)100:<24:MOOAR->2.0.ZU;2-Q
Abstract
Conventional drug therapy in rheumatoid arthritis (RA) has failed to c ontrol the longterm morbidity and mortality associated with RA. Simila rly, drug therapy for osteoarthritis (OA) can relieve symptoms, but it is not clear that it alters progression of disease. Three classes of drugs are widely used for treatment of RA: nonsteroidal anti-inflammat ory drugs (NSAIDs), corticosteroids, and the slow-acting agents. In mo st patients, pharmacologic therapy is initiated with NSAIDs. These dru gs can relieve symptoms but do not alter the course of the disease. Th e gastrointestinal and other side effects attributed to these compound s are well known. Similarly, use of corticosteroids can provide rapid pain relief to patients with RA and, if used in low doses, pose limite d risk of toxicity. Slow-acting agents, including gold, D-penicillamin e, and methotrexate, appear to decrease radiographic progression and i mprove clinical and biochemical indicators of RA. Therefore, newer tre atment philosophies encourage use of slow-acting agents earlier in the course of the disease in order to prevent or diminish bone and joint erosions and destruction and other manifestations of disease progressi on. Drugs under investigation for the treatment of arthritis appear to exhibit disease-modifying or immunomodulating properties. Tenidap is a novel agent that possesses a dual mechanism of action: cyclooxygenas e inhibition and modulation of cytokine activity. In addition, several biologic agents, including antibodies to tumor necrosis factor-alpha (TNF-alpha) and to intercellular adhesion molecule-1, may prove useful . These immunotherapeutic strategies are based on knowledge of the rol e of cytokines in the inflammatory process in arthritis. Osteoarthriti s may be managed using drug and nondrug modalities. Weight loss is esp ecially important when OA is in the weight-bearing joints. Biopsies of synovium from patients with OA show evidence of inflammation, but whe ther this disease should be treated with analgesics alone or with anti -inflammatory drugs remains controversial. Other treatment modalities, including tissue transplants and cytokine-modulating drugs, are emerg ing for the potential therapy of OA. Surgery may also be appropriate i f drug treatment fails to control symptoms.