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Terapias biológicas e a artrite reumatóide
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A artrite reumatóide é uma doença autoimune, de etiologia desconhecida, caracterizada pela destruição, mais ou menos gradual, das articulações, podendo essa destruição estender-se até à cartilagem e ossos. Afeta sobretudo mulheres, e a sua incidência é maior com o avançar da idade. Um diagnóstico precoce e tratamento adequado são dois fatores preditivos de bom prognóstico. Os objetivos do tratamento são a redução da inflamação, alívio da dor e impedir a disfunção articular. Tal pode ser conseguido não só com tratamento farmacológico, mas também colocando em prática medidas não farmacológicas, como a prática de exercício físico regular e uma alimentação cuidada. Relativamente ao tratamento farmacológico, irá variar de acordo com a atividade da doença e manifestação de sintomas, que geralmente incluem rigidez matinal, poliartrite simétrica com envolvimento das articulações das mãos e fadiga. Habitualmente, para um controlo inicial da doença e, se possível, a sua remissão (que raramente é alcançada) são administrados, em primeira linha, antirreumatismais clássicos de que é exemplo o metotrexato, em conjunto com glucocorticoides em baixa dose, até que os antirreumatismais convencionais comecem a exercer a sua ação imunossupressora, que usualmente tem início no período de alguns meses. Em indivíduos reumáticos que se mostram intolerantes aos fármacos antirreumatismais clássicos e/ou há falha na remissão da doença, as terapias biológicas constituem, em grande parte dos casos, uma escolha eficaz. Os fármacos biológicos, de acordo com a classe a que pertencem, podem inibir a ação de citocinas próinflamatórias como o TNF-α, IL-1, Il-6 ou o CD20. Em termos práticos, atuam na redução da inflamação, através da modulação da ação dos componentes do sistema imunitário. Porém, ainda que a introdução dos medicamentos biológicos tenha representado um marco importante no tratamento da artrite reumatóide, tal como acontece com todos os fármacos, sem exceção, os biológicos vêm com as suas desvantagens, sendo o custo elevado, a administração parentérica e os efeitos secundários algumas das razões que podem limitar a sua utilização mais ampla.
Neste sentido, esta monografia explora o modo como as terapias biológicas vieram alterar o paradigma do tratamento, assim como os riscos associados à imunossupressão e o futuro destas terapêuticas.
Rheumatoid arthritis is an autoimmune disease of unknown etiology, characterized by the more or less gradual destruction of the joints, and that destruction may extend to the cartilage and bones. It mainly affects women, and its incidence increases with advancing age. An early diagnosis and adequate treatment are two predictive factors of a good prognosis. Treatment goals are reduction of inflammation, pain relief and prevention of joint dysfunction. This can be achieved not only with pharmacological treatment, but also by practicing non-pharmacological measures, such as regular physical activity and a balanced diet. Regarding the pharmacological treatment, it will vary according to the disease activity and manifestation of symptoms, which generally include morning stiffness, symmetrical polyarthritis with involvement of the hand joints, fatigue and weight loss. Usually, for an initial control of the disease and, if possible, its remission (which is rarely achieved), classic antirheumatic drugs are administered as the first line, such as methotrexate, with low-dose glucocorticoids, until the conventional disease-modifying antirheumatic drugs begin to exert their immunosuppressive action, which usually starts within a few months. In individuals with rheumatic disease who are intolerant to classic antirheumatic drugs and/or there is failure to control the disease, biological therapies are, in most cases, an effective choice. Biological drugs, according to the class to which they belong, can inhibit the action of pro-inflammatory cytokines such as TNF-α, IL-1, IL-6 or CD20. Practically speaking, they act to reduce inflammation by modulating the action of immune system components. However, even though the introduction of biological agents has represented an important milestone in the treatment of rheumatoid arthritis, as it happens with all drugs, without exception, biological agents come with their disadvantages, being the high cost, parenteral administration and adverse reactions some of the reasons that may limit its wider use. Therefore, this monograph explores how biological therapies have changed the treatment paradigm, as well as the risks associated with immunosuppression and the future of these therapies.
Rheumatoid arthritis is an autoimmune disease of unknown etiology, characterized by the more or less gradual destruction of the joints, and that destruction may extend to the cartilage and bones. It mainly affects women, and its incidence increases with advancing age. An early diagnosis and adequate treatment are two predictive factors of a good prognosis. Treatment goals are reduction of inflammation, pain relief and prevention of joint dysfunction. This can be achieved not only with pharmacological treatment, but also by practicing non-pharmacological measures, such as regular physical activity and a balanced diet. Regarding the pharmacological treatment, it will vary according to the disease activity and manifestation of symptoms, which generally include morning stiffness, symmetrical polyarthritis with involvement of the hand joints, fatigue and weight loss. Usually, for an initial control of the disease and, if possible, its remission (which is rarely achieved), classic antirheumatic drugs are administered as the first line, such as methotrexate, with low-dose glucocorticoids, until the conventional disease-modifying antirheumatic drugs begin to exert their immunosuppressive action, which usually starts within a few months. In individuals with rheumatic disease who are intolerant to classic antirheumatic drugs and/or there is failure to control the disease, biological therapies are, in most cases, an effective choice. Biological drugs, according to the class to which they belong, can inhibit the action of pro-inflammatory cytokines such as TNF-α, IL-1, IL-6 or CD20. Practically speaking, they act to reduce inflammation by modulating the action of immune system components. However, even though the introduction of biological agents has represented an important milestone in the treatment of rheumatoid arthritis, as it happens with all drugs, without exception, biological agents come with their disadvantages, being the high cost, parenteral administration and adverse reactions some of the reasons that may limit its wider use. Therefore, this monograph explores how biological therapies have changed the treatment paradigm, as well as the risks associated with immunosuppression and the future of these therapies.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2023, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Artrite reumatóide Articulações Inflamação Imunossupressão Terapias biológicas Mestrado Integrado - 2023