Phenytoin in rheumatoid arthritis.

Grindulis, K. A.; Nichol, F. E.; Oldham, R

doi:10.1136/ard.47.3.261-a

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…Conversely, since AEDs demonstrate some neuroprotective properties, it is also reasonable to speculate that the treatment for epilepsy may be protective against AD. Phenytoin, for instance, is known to possess anti-inflammatory activity [4,5] and may thereby act to delay AD onset, as is seen with non-steroidal anti-inflammatory drugs [6,7]. There is also evidence that phenytoin can prevent neurotoxicity resulting from NMDA receptor hypofunction, suggesting it could be of benefit in neurodegenerative disorders [8].…”

Section: Introductionmentioning

confidence: 98%

Epilepsy and antiepileptic drug use in elderly people as risk factors for dementia

Carter

Weaver

Joudrey

et al. 2007

Journal of the Neurological Sciences

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Section: Introductionmentioning

confidence: 98%

Epilepsy and antiepileptic drug use in elderly people as risk factors for dementia

Carter

Weaver

Joudrey

et al. 2007

Journal of the Neurological Sciences

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“…Interestingly, however, phenytoin has also been proposed for the treatment of rheumatoid arthritis, since patients on this anticonvulsant have been noticed to have less severe rheumatoid arthritis (Grindulis et al 1986;MacFarlane et al 1986). …”

Section: Autoimmune Diseasesmentioning

confidence: 98%

Immunological Adverse Effects of Anticonvulsants

et al. 1993

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Long term administration of anticonvulsants is sometimes associated with impairment of the humoral and/or cellular immune response. Furthermore, certain well known adverse reactions to antiepileptics may have an immunotoxicological origin e.g. lymphadenopathy, pseudolymphoma and systemic lupus erythematosus. However, two important questions remain unresolved. First, the possibility that epilepsy per se might be primarily associated with immune alterations makes it difficult to assess the pathogenetic role of a specific drug, especially in a patient population usually on multiple drug therapy. Secondly, the clinical relevance of some of the observed immunological abnormalities is still highly controversial. This review is intended to give an outline of the present state of knowledge on the effects of anticonvulsants on humoral, cellular and nonspecific immunity, with particular regard to some of the major clinical conditions that have been ascribed to drug-induced immune dysregulation, such as pseudolymphoma and systemic autoimmune diseases. The immunotoxic potential of anticonvulsants appears to be low, and immunological monitoring is not usually required except in patients with known immune defects.

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“…Phenytoin inhibits the production of superoxide anion by immune cells [ 18 ] and significantly improves rheumatoid arthritis, a cell-mediated autoimmune disorder [ 19 ].…”

Section: Iv) Phenytoin Exerts An Inhibitory Effect On the Pathomechanmentioning

confidence: 99%

Phenytoin as a novel anti-vitiligo weapon

Namazi

2005

J Autoimmune Dis

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Vitiligo is a psychologically devastating clinical conundrum which affects approximately 1% of the general population. The exact cause of the illness is an enigma, but several hypotheses about its pathogenesis are advanced.The autoimmune hypothesis proposes an autoimmune attack against melanocytes. Although anti-melanocyte autoantibodies have been demonstrated in vitiligo, recent research casts doubt on their pathogenic role and instead supports the involvement of cell-mediated autoimmune response in the pathobiology of this disorder, which is characterized by increase of suppressor T-cells and decrease of the helper/suppressor ratio in association with the presence of type-1 cytokine secreting cytotoxic T cells in the vicinity of disappearing melanocytes.The neural hypothesis proposes that increased release of norepinephrine, a melanocytotoxin, from the autonomic nerve endings in the microenvironment of melanocytes injures these cells. Moreover, norepinephrine induces the catecholamine degrading enzyme monoamine oxidase (MAO), which favors the formation of toxic levels of hydrogen peroxide in the vicinity of melanocytes.Another theory suggests that abnormal permeability of melanosome membrane, which normally prevents the diffusion of toxic melanin precursors into the cytoplasm, may cause melanocyte damage.Phenytoin, the widely-used anticonvulsant, has been employed both topically and systemically in the treatment of some dermatological disorders. The drug has been shown to significantly suppress mitogen-induced activation of lymphocytes and cytotoxic T lymphocyte activity and to polarize the immune response toward the type-2 pathway. It also significantly decreases suppressor T cells and increases the helper/suppressor ratio.At high concentrations, the drug inhibits the release of norepinephrine and the activity of MAO. Moreover, phenytoin is suggested to interact with membrane lipids, which may promote stabilization of the membranes.The hydantoin moiety of phenytoin exerts a direct stimulatory action on melanocytes; facial hyperpigmentation is a recognized side effect of orally administered phenytoin.Altogether, the above evidence suggests that phenytoin could be therapeutically effective against vitiligo. As phenytoin stimulates collagen production and inhibits its breakdown, its concomitant use with topical steroids could prevent steroid-induced skin atrophy while potentiating the anti-vitiligo effect of these agents.

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Phenytoin in rheumatoid arthritis.

Abstract: The most appropriate assessment of phenytoin in RA may be by its long term effects on bone assessed radiographically and to our knowledge this has not been examined. Although 'phenytoin is unlikely to become a first choice second line agent',' it should not now be dismissed.

Cited by 4 publications

References 6 publications

Epilepsy and antiepileptic drug use in elderly people as risk factors for dementia

Epilepsy and antiepileptic drug use in elderly people as risk factors for dementia

Immunological Adverse Effects of Anticonvulsants

Phenytoin as a novel anti-vitiligo weapon

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