Chronic Diseases Therapeutic Interchanges Drug Therapy: A Narrative Reviews

Objective: To review the chronic diseases (gastrointestinal disorders, rheumatic arthritis etc.) therapeutic interchanges drug therapy. Methods: It is an extensive search, or fifty databases included the following through the Saudi Digital Library (SDL) searching engine. It included the various types of studies (meta-analysis, randomized controlled studies and observational studies) in the English language with human study only for the update May 2017. The search in terms of therapeutic interchange, medication, therapy and type of disease or medication based on therapeutics class of anti-psychiatric. The medication list and switch from one drug to alternative based on the literature found the search that has included comparative safety, efficacy and cost of the type of medication for each disease and national or international evidence-based guidelines. Results: The total number of studies after an extensive search with a specific term search was 487 studies. Of those, there were 107 duplicated studies, and 380 studies included for future evaluation. After evaluation, there were 19 studies about therapeutic interchange of chronic medications (Rheumatoid arthritis (RA) or Gastrointestinal disorder (GIT). Of those 19 studies, eight studies included for evaluation. Conclusion: Gastrointestinal and rheumatic arthritis medications, therapeutic interchange more practical and prevent the economic burden on healthcare systems. The implementation of therapeutic interchange of those medications is highly recommended at healthcare institutions in the Kingdom of Saudi Arabia.

Retorno a las básicas, músculo como órgano anti-inflamatorio en paciente con artritis reumatoide

RESUMEN Mujer en cuarta década de la vida, con antecedente de hipotiroidismo, tuberculosis latente y artritis reumatoide, quien no responde a manejo inmunomodulador crónico con distintos esquemas terapéuticos, es valorada por grupo interdisciplinar de endocrinología, medicina interna, medicina del deporte y psicología evidenciando sobrepeso, con alteración de la masa muscular esquelética, masa grasa, grasa visceral y en exámenes complementarios una inadecuada excursión de la glucosa con insulina basal elevada. Se orienta manejo con estrategia nutricional, deportiva y cognitivo conductual logrando resolución de los síntomas y suspensión del tratamiento farmacológico.

ABSTRACT 35 years old woman, with personal history of hypothyroidism, latent tuberculosis and rheumatoid arthritis, who does not respond to chronic immunomodulatory management with different therapeutic schemes, is valued by an interdisciplinary group of endocrinology, internal medicine, sports medicine and psychology, evidencing overweight, with alteration in skeletal muscle mass, fat mass, visceral fat and laboratories with inadequate excursion of glucose with high basal insulin. The management was oriented with nutritional, sports and cognitive behavioral strategy achieving resolution of symptoms and suspension of pharmacological treatment.

A Case of Rheumatic Arthritis Successfully Treated by Boiogito and Yokuininto with Bushi / 日本東洋医学雑誌

Here I report a case of chronic rheumatic arthritis, which was successfully treated with boiogito, yokuininto and bushi, leading to complete remission. A 38 year-old woman, null gravida, has been suffering from strong pain and frequent sense of numb in both hand joints. Previous orthopedic specialist diagnosed as rheumatic arthritis. Since she had a hope of getting pregnant, she came to our outpatient clinic, seeking Kampo treatment. Clinical examination revealed a positive test of anti-CCP antibody (>200) or rheumatoid factor as 32.4. Kampo treatment was started with keishikajutsubuto besides bushi, or eppikajutsuto with bushi, which were not effective sufficiently. Finally, combined agents with yokuininto and boiogito dramatically reduced pain, visual analogue scale score or CRP level, and relieved pain in bilateral hand joints, leading to complete remission. Yokuininto is applied to the cases with pains, chilliness or sense of numb in limb joints or muscles. Furthermore, boiogito is administered to the patients with edematous, painful and/or swollen joints. Both agents contain several herbal medicines with pain relieving spasmolytics, redistributing of tissue fluid or anti-inflammatory actions. From these findings, agents used in this case appear to work towards redistributing tissue fluid, easing local immune reaction or relieving pains powerfully. It is thought that combined agents with boiogito and yokuininto could be a reliable option for the treatment of rheumatic arthritis.

Diagnostic value of P2X7 receptor and its role in inflammatory reaction in rheumatoid arthritis / 南方医科大学学报

OBJECTIVE@#To study the diagnostic value of P2X7 receptor for rheumatoid arthritis (RA) and its role in the inflammatory response.@*METHODS@#With the synovial tissues from 25 patients with bone and joint replacement as the control,the synovial tissues of 25 RA patients were examined for the relative expression of P2X7 receptor mRNA using qRT-PCR.In an immortalized RA synovial cell line (MH7A),the effect of P2X7 receptor knockdown via a small interfering RNA were examined on the productions of the inflammatory cytokines including interleukin-1β(IL-1β),IL-6,and IL-8 using ELISA.@*RESULTS@#The RA patients showed significantly higher levels of P2X7 receptor mRNA expression in the synovial tissue than the control patients.P2X7 receptor had a good diagnostic value for RA.The expression levels of IL-1β,IL-6,and IL-8 were positively correlated with the levels of P2X7 receptor in the synovial tissues of RA patients (<0.001).In MH7A cells,P2X7 receptor knockdown obviously reduced the secretion of IL-1β and IL-6.@*CONCLUSIONS@#RA patients show elevated P2X7 receptor level in the synovial tissue, which has a good diagnostic value for RA.Blocking P2X7 receptor can inhibit inflammatory factor secretion and suppress inflammatory reactions.

Systemic Amyloid Protein a Amyloidosis Involving the Heart in a Patient with Rheumatoid Arthritis / 대한내과학회지

Amyloidosis can be identified by the deposition of amyloid fibrils in biopsy specimens from multiple organs, including the heart, kidney, skin, and bowel. Systemic amyloid protein A amyloidosis (AA amyloidosis) is commonly associated with chronic inflammatory diseases or chronic infectious conditions. Cardiac involvement in AA amyloidosis is found in < 1% of reported cases. Here, we report a case of cardiac AA amyloidosis confirmed by heart biopsy in a 54-year-old-female with a medical history of rheumatoid arthritis and stage 4 chronic kidney disease due to renal amyloidosis. She had suffered from progressive aggravation of dyspnea for 2 years. Infiltrative disease involving the heart was suspected by echocardiography, and the patient was diagnosed with AA amyloidosis involving the heart by cardiac biopsy. This is a rare case of cardiac involvement in a patient with systemic AA amyloidosis associated with rheumatoid arthritis.

A Case of Disseminated Cryptococcosis with Skin Involvement in a Rheumatic Arthritis Patient During Long-term Tacrolimus Therapy / 대한의진균학회지

Cryptococcosis is the infection caused by the encapsulated yeast Cryptococcus species, occuring most frequently in immunocompromised hosts. Cutaneous cryptococcosis occurs in 10~15% of disseminated cases and its clinical manifestation is variable. The patient was a 73-year-old female, who had been taking a tacrolimus 3 mg/day for 2 years due to rheumatic arthritis. She had an erythematous ulcerated lesion with elevated border on right shoulder and left back, and painful subcutaneous nodules on left chest. Histopathologic examination of skin showed typical spores with capsules in dermis and chest X-ray showed fungal ball in lung. She was successfully treated by systemic amphotericin B and fluconazole. Herein, we report a case of disseminated cryptococcosis with skin involvement during long-term tacrolimus therapy.

The Influences of Immune Suspression by Oral Administration of Type Ⅱ Collagen on Rat Rheumatic Osteoarthritis and Traumatic Osteoarthritis / 中国运动医学杂志

Purpose: To study the influences of immune suspression by oral administration of type Ⅱ collagen on the pathogenesis of collagen induced arthritis(CIA) and traumatic oseoarthritis(OA) in rats; Methods: Rat knee traumatic osteoarthritis model made by excision of medial collateral ligament and medial meniscetomy and CIA model were applied for the observation of the changes on hisological and histochemical staining and the inhibition of T cells after oral administration of type Ⅱ collagen. Results: In OA, although the T cells were suspressed by oral administration of type Ⅱ collagen, however, the the pathogenesis was not hindered comparing with RA. It indicated that for OA, machanical factor is more important than the immunological factor, oral administration of type Ⅱ collagen has little effect on decreasing the speed of development of OA. It is not adequate to take the remedy of oral administation of type Ⅱ collagen for the treatment of OA.