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ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR

Year 2010, Volume: 19 Issue: 1, 74 - 84, 01.03.2010

Abstract

Romatoid artrit(RA)’te tedavi yaklaşımlarının temel amacı, en kısa zamanda remisyon sağlanarak eklem hasarının önlenmesidir. Romatoid artrit tedavisinde non-steroidal anti inflamatuar ilaçlar ve kortikosteroidlerin, etkilerinin kısa sürede başlamasına rağmen hastalığın sürecini değiştirmede ve eklem hasarını önlemede pek etkileri yoktur. Bu sebeple tedaviye hastalık modifiye edici antiromatizmal ilaçların(DMARD) eklenmesi gerekmektedir. Kullanılan DMARD’lerde toksisite izlemi dikkatle yapılmalıdır. DMARD’ler hastalık bulgularını birçok hastada tam olarak kontrol edememektedir. Klasik tedaviye yanıt vermeyen hastalar için alternatif tedavi rejimleri mevcuttur. Romatoid artritte kullanılan geleneksel ve yeni tedavi yaklaşımları sunulacaktır

References

  • Harris ED JR. Rheumatoid arthritis. Pathophysiology and implications for therapy. N Engl J Med 1990; 3;322(18):1277-1289.
  • 2002 Update American College of Rheumatology Subcommitee on Rheumatoid Arthtitis Guidelines. Guidelines for the management of rheumatoid arthritis: Arthritis Rheum 2002;46:328-346.
  • Karadağ O, Kiraz S. Romatoid artrit tedavisi: kısa etkili ilaçlar (nonsteroidal antiinflamatuar ilaçlar ve steroidler). Türkiye Klinikleri J Int Med Sci 2006; 2(25):46-51.
  • Haris ED JR, Budd RC, Firestein GS, et al. Kelley’s Textbook of Rheumatology. Çeviri ed: Arasıl T. Bölüm Çeviri: Sivrioğlu K. Bölüm: Romatoid Artritin Tedavisi. Kitap: Kelley Romatoloji. Güneş Kitabevi, Ankara 2006; ss 1079-1100.
  • Katz WA, Rothenberg R. Section 4: Treating the patient in pain. J Clin Rheumatol 2005;11 (2 Suppl):S16-27, discussion S27-28.
  • Kean WF, Buchanan WW. The use of NSAIDs in rheumatic disorders 2005: a global perspective. Inflammopharmacology 2005; 13 (4): 343-370.
  • Singh G, Ramey DR, Morfeld D, et al. Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med 1996; 22;156(14):1530-1536.
  • Malysheva OA, Wahle M, Wagner U, et al. Low-dose prednisolone in rheumatoid arthritis: adverse effects of various disease modifying antirheumatic drugs. J Rheumatol 2008; 35(6):979-985.
  • Iikuni N, Inoue E, Tanaka E, et al. Low disease activity state with corticosteroid may not represent ‘true’ low disease activity state in patients with rheumatoid arthritis. Rheumatology (Oxford) 2008; 47(4):519-521.
  • Giles JT, Bathon JM. Management of rheumatoid arthritis: synovitis. In: Hochberg MC, Silman AJ, Smolen JS,Weinblatt M, Weisman MH (eds.) Rheumatology 4th ed. Mosby Elsevier Philladelphia; 2008; pp 887- 896.
  • Yurdakul S. Uzun etkili ilaçlar. Türkiye Klinik- leri J Int Med Sci 2006; 2(25):52-59.
  • Turkiewicz AM, Moreland LW. Romatoid artrit. In: Barlett SJ (ed.) Çev. ed: Dinç A. Romatizmal Hastalıklarda Klinik Tedavi 2007; pp 157-166.
  • Chatnam WW. Traditional disease modifying antirheumatic drugs: gold compounds, D- penicillamin, sulfasalazine and antimallarials. In: Kopman WJ, Moreland LW (eds.) Arthritis and Allied conditions 15th ed. Lippincott Williams & Wilkins, Philadelphia 2005; pp 915-944.
  • Zvaifler NJ, Corr M. Evaluation and Treatment of Rheumatoid Arthritis. In. Koopman WJ, Moreland LW (eds.) Arthritis and Allied Conditions 15th ed. Lippincott Williams & Wilkins, Philadelphia 2005; pp 1249-1262.
  • Capell HA Madhok R. Disease Modifying drugs: antirheumatic
  • Hochberg MC Silman AJ Smolen JS (eds.) Rheumatology 4th ed. Mosby Elsevier, Philladelphia 2008; pp 437-447.
  • In: 16. Jones G, Brooks PM. Injectable gold compounds: an overview. Br J Rheumatol 1996; 35(11):1154-1158.
  • Lehman AJ, Esdaile JM, Klinkhoff AV, et al; METGO Study Group. A 48-week, randomized, double-blind,
  • controlled multicenter trial of combination methotrexate and intramuscular gold therapy in rheumatoid arthritis: results of the METGO study. Arthritis Rheum 2005; 52(5):1360-1370. 18.Top C, Terekeci H. Romatoid Artrit Tedavisin- de Hastalığı Modifiye Eden Anti-Romatizmal
  • İlaçlar. Türkiye Klinikleri J Med Sci 2008; 28:387-398.
  • Munro R, Capell HA. Penicillamine. Br J Rheumatol 1997; 36(1):104-109.
  • Swierkot J, Szechiński J. Methotrexate in rheumatoid arthritis. Pharmacol Rep 2006; 58 (4):473-492.
  • Borchers AT, Keen CL, Cheema GS, Gershwin ME. The use of methotrexate in rheumatoid arthritis. Semin Arthritis Rheum 2004; 34 (1):465-83.
  • Güzel R. Romatoid artrit ve DMARD’lar. Tür- kiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2008; 54 Özel sayı 1;25-30.
  • Grennan DM, Gray J, Loudon J, Fear S. Methotrexate complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 2001; 60(3):214-217.
  • Kırnap M, Demir H, Kalkan A. Comparison of the efficacy and side effectes of cyclosporine-A and methotrexate in the treatment of the patients with rheumatoid arthritis. Erciyes Tıp Dergisi (Erciyes Medical Journal) 2000; 22 (4) 178-184.
  • Salliot C, van der Heijde D. Long term safety of Methotrexate monotherapy in rheumatoid arthritis patients: A systematic literature research. Ann Rheum Dis 2009; 68(7):1100- 1104.
  • Ertenli İ. Romatoid artritte yeni tedaviler. Tür- kiye Klinikleri J Int Med Sci 2006; 2(25):60- 64.
  • Cush JJ, Kavanaugh A. TNF-α blocking therapies. In: Hochberg MC Silman AJ Smolen JS (eds.) Rheumatology Mosby Elsevier, Philladelphia 2008; pp 501-518.
  • Kıralp MZ. Romatoid artritin yeni zemin teda- vileri-derleme. Türkiye Fiziksel Tıp ve Rehabi- litasyon Dergisi 2003; 49(2).
  • Van der Heijde D, Burmester G, Melo-Gomes J, et al. Inhibition of radiographic progression with combination etanercept and methotrexate in patients with moderately active rheumatoid arthritis previously treated with monotherapy. Ann Rheum Dis 2009; 68(7):1113-1118.
  • Breedveld FC, Weisman MH, Kavanaugh AF, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 2006; 54(1):26-37.
  • Strangfeld A, Hierse F, Kekow J, et al. Comparative effectiveness of TNFalpha inhibitors in combination with either methotrexate or leflunomide. Ann Rheum Dis 2009; 68(12):1856-1862.
  • Ardışen E, Gürer MA. Biyolojik ajanların yan etkileri. Dermatose 2006; 5(3):174-180.
  • Mertens M, Singh JA. Anakinra for rheumatoid arthritis: a systematic review. J Rheumatol 2009; 36(6):1118-1125.
  • Choy EHS, Kingsley GH, Panayi GS. Immunotherapies: T and B cell. In: Hochberg MC, Silman AJ, Smolen JS,Weinblatt M, Weisman MH (eds. ) Rheumatology 4th ed. Mosby Elsevier, Philladelphia 2008; pp 481- 486.
  • Emery P, Fleischmann R, Filipowicz- Sosnowska A, et al; DANCER Study Group. The efficacy and safety of rituximab in patients with active RA despite methotrexate treatment: results of a phase IIB randomized, double- blind,
  • trial.Arthritis Rheum 2006; 54 (5):1390-1400.
  • dose-ranging 36. Cohen SB, Emery P, Greenwald MW, et al; REFLEX Trial Group. Rituximab for RA refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum. 2006; 54 (9):2793-2806.
  • Keystone E, Fleischmann R, Emery P, et al. Safety and efficacy of additional courses of rituximab in patients with active rheumatoid arthritis: an open-label extension analysis. Arthritis Rheum 2007; 56(12):3896-3908.

Traditional and Up-to-date Treatment in Rheumatoid Arthtiris

Year 2010, Volume: 19 Issue: 1, 74 - 84, 01.03.2010

Abstract

In rheumatoid arthritis (RA), the aims of therapeutic strategies are to obtain remission and prevent joint destruction as early as possible. Although the effects of non-steroidal antiinflammatory drugs and corticosteroids initiate after a short time, they are not very sufficient in changing the process of rheumatoid arthritis and preventing the joint damage. For this reason, it has to be combined with disease modifying antirheumatic drugs (DMARD). Toxicity of the drugs should be monitored carefully. DMARD cannot fully control disease findings in most patients. There are alternative treatment regimes for unresponsive patients to classical treatment. Traditional and new drugs for rheumatoid arthritis will be reviewed separately

References

  • Harris ED JR. Rheumatoid arthritis. Pathophysiology and implications for therapy. N Engl J Med 1990; 3;322(18):1277-1289.
  • 2002 Update American College of Rheumatology Subcommitee on Rheumatoid Arthtitis Guidelines. Guidelines for the management of rheumatoid arthritis: Arthritis Rheum 2002;46:328-346.
  • Karadağ O, Kiraz S. Romatoid artrit tedavisi: kısa etkili ilaçlar (nonsteroidal antiinflamatuar ilaçlar ve steroidler). Türkiye Klinikleri J Int Med Sci 2006; 2(25):46-51.
  • Haris ED JR, Budd RC, Firestein GS, et al. Kelley’s Textbook of Rheumatology. Çeviri ed: Arasıl T. Bölüm Çeviri: Sivrioğlu K. Bölüm: Romatoid Artritin Tedavisi. Kitap: Kelley Romatoloji. Güneş Kitabevi, Ankara 2006; ss 1079-1100.
  • Katz WA, Rothenberg R. Section 4: Treating the patient in pain. J Clin Rheumatol 2005;11 (2 Suppl):S16-27, discussion S27-28.
  • Kean WF, Buchanan WW. The use of NSAIDs in rheumatic disorders 2005: a global perspective. Inflammopharmacology 2005; 13 (4): 343-370.
  • Singh G, Ramey DR, Morfeld D, et al. Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med 1996; 22;156(14):1530-1536.
  • Malysheva OA, Wahle M, Wagner U, et al. Low-dose prednisolone in rheumatoid arthritis: adverse effects of various disease modifying antirheumatic drugs. J Rheumatol 2008; 35(6):979-985.
  • Iikuni N, Inoue E, Tanaka E, et al. Low disease activity state with corticosteroid may not represent ‘true’ low disease activity state in patients with rheumatoid arthritis. Rheumatology (Oxford) 2008; 47(4):519-521.
  • Giles JT, Bathon JM. Management of rheumatoid arthritis: synovitis. In: Hochberg MC, Silman AJ, Smolen JS,Weinblatt M, Weisman MH (eds.) Rheumatology 4th ed. Mosby Elsevier Philladelphia; 2008; pp 887- 896.
  • Yurdakul S. Uzun etkili ilaçlar. Türkiye Klinik- leri J Int Med Sci 2006; 2(25):52-59.
  • Turkiewicz AM, Moreland LW. Romatoid artrit. In: Barlett SJ (ed.) Çev. ed: Dinç A. Romatizmal Hastalıklarda Klinik Tedavi 2007; pp 157-166.
  • Chatnam WW. Traditional disease modifying antirheumatic drugs: gold compounds, D- penicillamin, sulfasalazine and antimallarials. In: Kopman WJ, Moreland LW (eds.) Arthritis and Allied conditions 15th ed. Lippincott Williams & Wilkins, Philadelphia 2005; pp 915-944.
  • Zvaifler NJ, Corr M. Evaluation and Treatment of Rheumatoid Arthritis. In. Koopman WJ, Moreland LW (eds.) Arthritis and Allied Conditions 15th ed. Lippincott Williams & Wilkins, Philadelphia 2005; pp 1249-1262.
  • Capell HA Madhok R. Disease Modifying drugs: antirheumatic
  • Hochberg MC Silman AJ Smolen JS (eds.) Rheumatology 4th ed. Mosby Elsevier, Philladelphia 2008; pp 437-447.
  • In: 16. Jones G, Brooks PM. Injectable gold compounds: an overview. Br J Rheumatol 1996; 35(11):1154-1158.
  • Lehman AJ, Esdaile JM, Klinkhoff AV, et al; METGO Study Group. A 48-week, randomized, double-blind,
  • controlled multicenter trial of combination methotrexate and intramuscular gold therapy in rheumatoid arthritis: results of the METGO study. Arthritis Rheum 2005; 52(5):1360-1370. 18.Top C, Terekeci H. Romatoid Artrit Tedavisin- de Hastalığı Modifiye Eden Anti-Romatizmal
  • İlaçlar. Türkiye Klinikleri J Med Sci 2008; 28:387-398.
  • Munro R, Capell HA. Penicillamine. Br J Rheumatol 1997; 36(1):104-109.
  • Swierkot J, Szechiński J. Methotrexate in rheumatoid arthritis. Pharmacol Rep 2006; 58 (4):473-492.
  • Borchers AT, Keen CL, Cheema GS, Gershwin ME. The use of methotrexate in rheumatoid arthritis. Semin Arthritis Rheum 2004; 34 (1):465-83.
  • Güzel R. Romatoid artrit ve DMARD’lar. Tür- kiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2008; 54 Özel sayı 1;25-30.
  • Grennan DM, Gray J, Loudon J, Fear S. Methotrexate complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 2001; 60(3):214-217.
  • Kırnap M, Demir H, Kalkan A. Comparison of the efficacy and side effectes of cyclosporine-A and methotrexate in the treatment of the patients with rheumatoid arthritis. Erciyes Tıp Dergisi (Erciyes Medical Journal) 2000; 22 (4) 178-184.
  • Salliot C, van der Heijde D. Long term safety of Methotrexate monotherapy in rheumatoid arthritis patients: A systematic literature research. Ann Rheum Dis 2009; 68(7):1100- 1104.
  • Ertenli İ. Romatoid artritte yeni tedaviler. Tür- kiye Klinikleri J Int Med Sci 2006; 2(25):60- 64.
  • Cush JJ, Kavanaugh A. TNF-α blocking therapies. In: Hochberg MC Silman AJ Smolen JS (eds.) Rheumatology Mosby Elsevier, Philladelphia 2008; pp 501-518.
  • Kıralp MZ. Romatoid artritin yeni zemin teda- vileri-derleme. Türkiye Fiziksel Tıp ve Rehabi- litasyon Dergisi 2003; 49(2).
  • Van der Heijde D, Burmester G, Melo-Gomes J, et al. Inhibition of radiographic progression with combination etanercept and methotrexate in patients with moderately active rheumatoid arthritis previously treated with monotherapy. Ann Rheum Dis 2009; 68(7):1113-1118.
  • Breedveld FC, Weisman MH, Kavanaugh AF, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 2006; 54(1):26-37.
  • Strangfeld A, Hierse F, Kekow J, et al. Comparative effectiveness of TNFalpha inhibitors in combination with either methotrexate or leflunomide. Ann Rheum Dis 2009; 68(12):1856-1862.
  • Ardışen E, Gürer MA. Biyolojik ajanların yan etkileri. Dermatose 2006; 5(3):174-180.
  • Mertens M, Singh JA. Anakinra for rheumatoid arthritis: a systematic review. J Rheumatol 2009; 36(6):1118-1125.
  • Choy EHS, Kingsley GH, Panayi GS. Immunotherapies: T and B cell. In: Hochberg MC, Silman AJ, Smolen JS,Weinblatt M, Weisman MH (eds. ) Rheumatology 4th ed. Mosby Elsevier, Philladelphia 2008; pp 481- 486.
  • Emery P, Fleischmann R, Filipowicz- Sosnowska A, et al; DANCER Study Group. The efficacy and safety of rituximab in patients with active RA despite methotrexate treatment: results of a phase IIB randomized, double- blind,
  • trial.Arthritis Rheum 2006; 54 (5):1390-1400.
  • dose-ranging 36. Cohen SB, Emery P, Greenwald MW, et al; REFLEX Trial Group. Rituximab for RA refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum. 2006; 54 (9):2793-2806.
  • Keystone E, Fleischmann R, Emery P, et al. Safety and efficacy of additional courses of rituximab in patients with active rheumatoid arthritis: an open-label extension analysis. Arthritis Rheum 2007; 56(12):3896-3908.
There are 40 citations in total.

Details

Other ID JA29VP67RC
Journal Section Research Article
Authors

Ayşın Demirel This is me

Mehmet Kırnap This is me

Publication Date March 1, 2010
Submission Date March 1, 2010
Published in Issue Year 2010 Volume: 19 Issue: 1

Cite

APA Demirel, A., & Kırnap, M. (2010). ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR. Sağlık Bilimleri Dergisi, 19(1), 74-84.
AMA Demirel A, Kırnap M. ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR. JHS. March 2010;19(1):74-84.
Chicago Demirel, Ayşın, and Mehmet Kırnap. “ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR”. Sağlık Bilimleri Dergisi 19, no. 1 (March 2010): 74-84.
EndNote Demirel A, Kırnap M (March 1, 2010) ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR. Sağlık Bilimleri Dergisi 19 1 74–84.
IEEE A. Demirel and M. Kırnap, “ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR”, JHS, vol. 19, no. 1, pp. 74–84, 2010.
ISNAD Demirel, Ayşın - Kırnap, Mehmet. “ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR”. Sağlık Bilimleri Dergisi 19/1 (March 2010), 74-84.
JAMA Demirel A, Kırnap M. ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR. JHS. 2010;19:74–84.
MLA Demirel, Ayşın and Mehmet Kırnap. “ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR”. Sağlık Bilimleri Dergisi, vol. 19, no. 1, 2010, pp. 74-84.
Vancouver Demirel A, Kırnap M. ROMATOİD ARTRİT TEDAVİSİNDE GELENEKSEL VE GÜNCEL YAKLAŞIMLAR. JHS. 2010;19(1):74-8.