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Importância dos marcadores na artrite reumatoide e o seu papel na terapêutica farmacológica
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Abstract(s)
A artrite reumatoide (AR) é uma doença inflamatória crónica, autoimune e
progressiva, e tem como principal manifestação as alterações a nível das articulações e
estruturas periarticulares. No entanto, devido ao seu caráter sistémico, pode apresentar
várias repercussões extra-articulares.
A etiologia permanece desconhecida, assumindo-se uma teoria multifatorial,
porém, fortemente influenciada por fatores ambientais e genéticos, existindo uma
sequência de aminoácidos comum partilhada pelos alelos do locus do DRB1 do complexo
leucocitário humano, que confere suscetibilidade à doença.
Carateriza-se por uma resposta imunitária exacerbada, com a produção de
autoanticorpos, que podem apresentar níveis séricos indicadores da doença, muito tempo
antes do aparecimento clínico da mesma.
O diagnóstico precoce é imprescindível para uma intervenção farmacológica
precoce e dirigida, o qual tem sido facilitado com a descoberta de biomarcadores cada
vez mais sensíveis e específicos. De entre estes, destacam-se os que, na fase inicial, se
relacionam com a atividade da doença e a lesão articular, sendo um importante contributo
para a identificação de indivíduos com uma evolução mais grave e progressiva da doença,
assim como indicadores da eficácia da terapêutica implementada.
O tratamento farmacológico pode ser realizado em regime de monoterapia ou
através de terapêutica combinada, e inclui o uso de anti-inflamatórios não esteroides,
glucocorticoides e fármacos antirreumáticos modificadores da evolução da doença. Os
agentes biológicos são a mais recente opção terapêutica, com uma resposta favorável nos
doentes com AR moderada a grave.
O Farmacêutico como profissional de saúde especialista do medicamento e, pela
sua proximidade à população, tem um papel essencial no aconselhamento e na melhoria
da adesão do doente à terapêutica.
Dado o impacto desta doença na qualidade de vida dos seus portadores, a presente
monografia teve como objetivo descrever os avanços alcançados, nos últimos anos, de
um melhor entendimento da AR, nomeadamente, a identificação precoce de marcadores
e a sua relação com o tratamento farmacológico, relevando o seu papel no diagnóstico e
prognóstico da doença nestes indivíduos.
Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune and progressive disease, and it manifests mainly on joints and periarticular structures. Due to its systemic nature, however, it may present several extra-articular repercussions. The etiology remains unknown, assuming a multifactorial theory which is strongly influenced by environmental and genetic factors. There is also a commonly found amino acid sequence shared by alleles of the DRB1 locus of the human leukocyte complex which confers susceptibility to the disease. It is characterized by an exacerbated immune response, with the production of autoantibodies, which may present serum levels long before the clinical onset of the disease. Early diagnosis is essential for an early, targeted pharmacological intervention, which has been facilitated through the discovery of biomarkers that are more and more sensitive and specific. Among these, those that stand out within the initial stages, relate to disease activity and joint damage and can both help identify individuals who are more likely to have a more serious and progressive course of the disease and be indicators in the effectiveness of the implemented therapy. Pharmacological treatment can be performed as monotherapy or through combined therapy, including the use of non-steroidal anti-inflammatory drugs, glucocorticoids and antirheumatic drugs that modify the course of the disease. The biological agents are the latest therapeutic option, with a favorable response in patients with moderate to severe RA. The Pharmacist as a health professional specialist of the drug and, due to the proximity of the population, has proved to be essential in counseling and in improving the patients adherence to therapy. Given the impact of this disease on the quality of life of its patients, this monography describes the developments in understanding RA in the recent years and associates the early identification of markers with pharmacological treatment, stressing its role and importance in diagnosis and prognosis in these patients.
Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune and progressive disease, and it manifests mainly on joints and periarticular structures. Due to its systemic nature, however, it may present several extra-articular repercussions. The etiology remains unknown, assuming a multifactorial theory which is strongly influenced by environmental and genetic factors. There is also a commonly found amino acid sequence shared by alleles of the DRB1 locus of the human leukocyte complex which confers susceptibility to the disease. It is characterized by an exacerbated immune response, with the production of autoantibodies, which may present serum levels long before the clinical onset of the disease. Early diagnosis is essential for an early, targeted pharmacological intervention, which has been facilitated through the discovery of biomarkers that are more and more sensitive and specific. Among these, those that stand out within the initial stages, relate to disease activity and joint damage and can both help identify individuals who are more likely to have a more serious and progressive course of the disease and be indicators in the effectiveness of the implemented therapy. Pharmacological treatment can be performed as monotherapy or through combined therapy, including the use of non-steroidal anti-inflammatory drugs, glucocorticoids and antirheumatic drugs that modify the course of the disease. The biological agents are the latest therapeutic option, with a favorable response in patients with moderate to severe RA. The Pharmacist as a health professional specialist of the drug and, due to the proximity of the population, has proved to be essential in counseling and in improving the patients adherence to therapy. Given the impact of this disease on the quality of life of its patients, this monography describes the developments in understanding RA in the recent years and associates the early identification of markers with pharmacological treatment, stressing its role and importance in diagnosis and prognosis in these patients.
Description
Keywords
Artrite reumatoide Diagnóstico Marcadores Autoanticorpos DMARDs