Nanometer preparation of traditional Chinese medicine for rheumatoid arthritis / 中国中药杂志

Rheumatoid arthritis( RA) is a chronic autoimmune disease,which can occur at any age. Repeated severe attacks can cause joint deformities. Its pathogenesis is complex,and the pathophysiological process involves many different types of cells. At present,the pathogenesis of RA is still unclear,and the clinical medication mainly aims to alleviate inflammation and symptoms.DMARDs,non-steroidal anti-inflammatory drugs,adrenocortical hormones,biological agents and traditional Chinese medicine are all applied in clinic. Traditional Chinese medicine has a long history in the treatment of RA. In particular,traditional Chinese medicine compounds can treat RA through multiple target points. The combination of nanotechnology and anti-inflammatory traditional Chinese and western medicines has also attracted extensive attention. Nanotechnology can selectively deliver drugs to articular cavity by taking advantage of its small carrier size and biodegradable materials. It can reduce the size of drug delivered,and increase the accuracy,safety and effectiveness of drugs,and further improve the therapeutic efficacy of drugs on RA. In this paper,traditional Chinese and western medicines and their nano-preparations used in the treatment of RA were reviewed in the past five years. The researches of nano-preparation were discussed in terms of pharmacology category. This paper provided reference for the research and development of new-type nano-preparation with outstanding clinical efficacy.

Tuberculosis in the era of anti-TNF-alpha therapy: Why does the risk still exist? / La tuberculosis en la era del tratamiento con fármacos inhibidores del factor de necrosis tumoral alfa: ¿por qué persiste el riesgo?

Abstract Rheumatoid arthritis is an autoimmune systemic disease characterized mainly by inflammatory compromise of diarthrodial joints. Multiple drug therapies have been developed to control the activity of rheumatoid arthritis, among them, the first line of disease-modifying antirheumatic drugs (DMARD), and novel drug therapies such as the anti-TNF alpha therapy, with satisfactory clinical outcomes. Despite this positive fact, the use of this therapy implies the risk of producing negative effects due to its mechanism of action, which has been associated with multiple infections, especially tuberculosis, making it necessary to use screen tests before resorting to this kind of drugs. We present the case of a 58-year-old female patient, with a six-year history of rheumatoid arthritis. The patient developed disseminated tuberculosis with compatible radiological and histological findings after receiving treatment with infliximab (anti-TNF therapy). No test was performed to screen for latent tuberculosis infection prior to the administration of infliximab. The performance of routine screenings tests for tuberculosis prior to anti-TNF alpha therapy plays an essential role in the detection of asymptomatic patients with latent tuberculosis. This is the only way to identify those patients who would benefit from anti-tuberculosis drugs before the initiation of anti-TNF alpha therapy, which makes the difference in the search of a significant reduction in the incidence of tuberculosis and its associated morbidity and mortality.

Resumen La artritis reumatoidea es una enfermedad crónica de carácter autoinmunitario caracterizada principalmente por el compromiso inflamatorio de las articulaciones cartilaginosas. Se han desarrollado múltiples tratamientos farmacológicos para controlar el avance de la artritis reumatoidea, entre ellos, los fármacos antirreumáticos modificadores de la enfermedad, además de nuevos esquemas terapéuticos con inhibidores del factor de necrosis tumoral alfa, con resultados clínicos satisfactorios. Sin embargo, el uso de tales medicamentos no resulta inocuo, ya que se los ha asociado con diversos efectos secundarios, especialmente, infecciones como la tuberculosis, lo cual exige la aplicación de pruebas de tamización antes de utilizarlos. Se reporta el caso de una paciente de 58 años de edad con artritis reumatoidea de seis años de evolución, que después de recibir tratamiento con uno de estos fármacos, el infliximab, desarrolló tuberculosis diseminada, cuyo diagnóstico se confirmó mediante radiología e histopatología. No se emplearon pruebas de detección de la tuberculosis latente antes de prescribirle el infliximab. Las pruebas de tamización para tuberculosis deben emplearse de forma rutinaria, con el fin de detectar aquellos pacientes con tuberculosis latente, ya que es la única manera de determinar si se requiere profilaxis antituberculosa antes de administrar dichos fármacos, hecho que marca la diferencia cuando se busca disminuir la incidencia de tuberculosis y la consecuente morbimortalidad.