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Artrite reumatoide : do diagnóstico à avaliação da eficácia da terapêutica
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A Artrite Reumatoide (AR) é a artrite inflamatória mais comum e está associada a incapacidade progressiva, complicações sistémicas, morte prematura e custos socioeconómicos. Embora a sua causa seja desconhecida, os avanços feitos na compreensão da patogénese da doença permitiram o desenvolvimento de fármacos com alvos específicos e melhores resultados. Sabe-se que a origem da doença assenta numa complexa interação entre fatores genéticos e fatores ambientais, em que a estimulação do sistema imunitário inato parece ser o fator iniciador. A passagem à doença clinicamente aparente ainda não está completamente esclarecida. O diagnóstico precoce é imprescindível para uma intervenção farmacológica precoce e individualizada e este tem sido facilitado com a descoberta de biomarcadores cada vez mais específicos e sensíveis. De entre estes, destacam-se os que, em fases iniciais da doença, se relacionam com a sua atividade e lesão articular, e que podem ajudar a identificar indivíduos que terão um curso da doença mais grave e progressivo. O tratamento farmacológico da AR pode ser realizado em monoterapia ou em combinação e inclui o uso de anti-inflamatórios não-esteroides, glucocorticoides e fármacos antirreumáticos modificadores da evolução da doença. O desenvolvimento de fármacos biológicos permitiu revolucionar o tratamento da AR. É essencial associar, à terapêutica farmacológica, medidas preventivas que permitam diminuir, ou mesmo evitar, o desenvolvimento de complicações associadas, quer à doença, quer à terapêutica farmacológica.
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and it is associated with progressive disability, systemic complications, premature death and socio-economic costs. Although its cause is unknown, the advances in understanding the pathogenesis of the disease allowed the development of drugs with specific targets and better outcomes. It is known that the origin of the disease relies on a complex interaction between genetic factors and environmental factors, in which the stimulation of the innate immune system seems to be the initiating factor. The transition to clinically apparent disease is not yet fully elucidated. Early diagnosis is essential for an early pharmacological and individualized intervention and this has been facilitated by the discovery of more specific and sensitive biomarkers. Among these, I highlight those which, in the early stages of the disease, are related to its activity and joint damage, and can help to identify individuals who will have a more severe and progressive course of the disease. Pharmacological treatment for RA can be performed alone or in combination and include the use of nonsteroidal anti-inflammatory drugs, glucocorticoids and disease-modifying antirheumatic drugs. The development of biological drugs has revolutionized the treatment of RA. It is essential to associate preventive measures to pharmacological therapy, to reduce or even prevent the development of complications associated with both the disease itself and therapy.
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and it is associated with progressive disability, systemic complications, premature death and socio-economic costs. Although its cause is unknown, the advances in understanding the pathogenesis of the disease allowed the development of drugs with specific targets and better outcomes. It is known that the origin of the disease relies on a complex interaction between genetic factors and environmental factors, in which the stimulation of the innate immune system seems to be the initiating factor. The transition to clinically apparent disease is not yet fully elucidated. Early diagnosis is essential for an early pharmacological and individualized intervention and this has been facilitated by the discovery of more specific and sensitive biomarkers. Among these, I highlight those which, in the early stages of the disease, are related to its activity and joint damage, and can help to identify individuals who will have a more severe and progressive course of the disease. Pharmacological treatment for RA can be performed alone or in combination and include the use of nonsteroidal anti-inflammatory drugs, glucocorticoids and disease-modifying antirheumatic drugs. The development of biological drugs has revolutionized the treatment of RA. It is essential to associate preventive measures to pharmacological therapy, to reduce or even prevent the development of complications associated with both the disease itself and therapy.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2016
Palavras-chave
Artrite reumatoide Anticorpos Citrulinação Citocinas Biomarcadores DMARDs Mestrado Integrado - 2016