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Novas abordagens terapêuticas para o tratamento da Artrite Reumatóide
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Abstract(s)
A Artrite Reumatóide (AR) é uma doença inflamatória, crónica e sistémica de natureza autoimune caraterizada por infiltração celular, hiperplasia sinovial e destruição da cartilagem articular progressiva, afetando principalmente as articulações das mãos, punhos e joelhos. Até à data, a sua fisiopatologia e etiologia permanecem desconhecidas, constituindo um obstáculo à sua prevenção e tratamento. Durante as últimas décadas, a prevalência da AR tem vindo a aumentar, nomeadamente nos países mais desenvolvidos, sobretudo em mulheres com mais de 50 anos. Ainda não existe uma cura e por isso o tratamento desta patologia centra-se no aumento de qualidade de vida e redução da sintomatologia e no alcance da remissão. O aparecimento dos fármacos
modificadores da doença revolucionou o tratamento da AR, no entanto, é necessário a utilização de anti-inflamatórios não-esteroides e corticosteroides como terapia adjuvante, de forma a diminuir o estado de inflamação e dor, presente no quadro clínico dos doentes. No entanto, as atuais terapêuticas convencionais e biológicas modificadoras da doença por vezes falham ou produzem apenas respostas parciais e estão associadas ao desenvolvimento de efeitos secundários indesejáveis, sendo que o alcance da remissão não é uma realidade na maioria dos casos. Neste sentido, é necessário desenvolver novas estratégias para os doentes que são refratários às terapêuticas existentes. Face ao exposto, esta dissertação irá consistir numa revisão bibliográfica da abordagem farmacológica da AR com enfoque nos avanços terapêuticos recentemente desenvolvidos na área. Destacando a utilização de células estaminais mesenquimais, alvos epigenéticos, inibidores do estimulador de colónias de macrófagos granulócitos, inibidores da via da quinase do 3-fosfatidilinositol, inibidores da tirosina quinase de Bruton e a utilização de sistemas de nanopartículas na administração de fármacos. Adicionalmente, o farmacêutico tem um papel fundamental na gestão e
acompanhamento da doença, devendo focar-se na educação do doente e na resposta às suas necessidades.
Rheumatoid arthritis (RA) is an inflammatory, chronic, and systemic autoimmune disease characterized by cellular infiltration, synovial hyperplasia and progressive articular cartilage destruction, mainly affecting the joints of the hands, wrists and knees. To date, its pathophysiology and etiology remain unknown, constituting an obstacle to its prevention and treatment. Over the last few decades, the prevalence of RA has been increasing, particularly in more developed countries, especially in women over the age of 50. As of yet, there is no cure and so the treatment of this condition focuses on increasing quality of life, reducing symptoms and achieving remission. The emerge of disease-modifying drugs has revolutionized the treatment of RA, however, it is necessary to use non-steroidal anti-inflammatory drugs and corticosteroids as adjuvant therapy to reduce the state of inflammation and pain present in the clinical condition of patients. However, current conventional and biological disease-modifying therapies sometimes fail or produce only partial responses and are associated with the development of undesirable side effects, thus achieving remission is not a reality in most cases. It is therefore necessary to develop new strategies for patients who are refractory to existing therapies. In view of the above, this dissertation will consist of a bibliographical review of the pharmacological approach to RA with a focus on the therapeutic advances recently developed in the area. In particular, the use of mesenchymal stem cells, epigenetic targets, granulocyte macrophage colony-stimulating factor inhibitors, 3-phosphatidylinositol kinase pathway inhibitors, Bruton tyrosine kinase inhibitors and the use of nanoparticle systems for drug delivery. In addition, pharmacists play a fundamental role in the management and monitoring of the disease and should focus on educating patients and responding to their needs.
Rheumatoid arthritis (RA) is an inflammatory, chronic, and systemic autoimmune disease characterized by cellular infiltration, synovial hyperplasia and progressive articular cartilage destruction, mainly affecting the joints of the hands, wrists and knees. To date, its pathophysiology and etiology remain unknown, constituting an obstacle to its prevention and treatment. Over the last few decades, the prevalence of RA has been increasing, particularly in more developed countries, especially in women over the age of 50. As of yet, there is no cure and so the treatment of this condition focuses on increasing quality of life, reducing symptoms and achieving remission. The emerge of disease-modifying drugs has revolutionized the treatment of RA, however, it is necessary to use non-steroidal anti-inflammatory drugs and corticosteroids as adjuvant therapy to reduce the state of inflammation and pain present in the clinical condition of patients. However, current conventional and biological disease-modifying therapies sometimes fail or produce only partial responses and are associated with the development of undesirable side effects, thus achieving remission is not a reality in most cases. It is therefore necessary to develop new strategies for patients who are refractory to existing therapies. In view of the above, this dissertation will consist of a bibliographical review of the pharmacological approach to RA with a focus on the therapeutic advances recently developed in the area. In particular, the use of mesenchymal stem cells, epigenetic targets, granulocyte macrophage colony-stimulating factor inhibitors, 3-phosphatidylinositol kinase pathway inhibitors, Bruton tyrosine kinase inhibitors and the use of nanoparticle systems for drug delivery. In addition, pharmacists play a fundamental role in the management and monitoring of the disease and should focus on educating patients and responding to their needs.
Description
Keywords
Artrite reumatóide Fármacos modificadores da doença Novas estratégias terapêuticas Tratamento farmacológico