The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

Malahias, Marco; Gardner, Horace T.; Hindocha, Sandip; Juma, Ali; Khan, WS

doi:10.2174/1874325001206010088

Cited by 11 publications

(4 citation statements)

References 77 publications

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“…To increase the bioavailability, the drug was formulated to SMEDDS gel which in turn enhance therapeutic efficacy by high permeation and SMEDDS gel avoids intestinal effect also. Hence it proves that SMEDDS gel is best way to deliver this drug for arthritis 3 .…”

Section: Ijpsr (2018) Volume 9 Issue 3 (Research Article)mentioning

confidence: 83%

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2018

IJPSR

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ABSTRACT:The present study was approached to prepare SMEDDS loaded herbal drug (THDC4-0475RD) for the arthritis through topical delivery by gel formulation(s). The efficiency of prepared SMEDDS and SMEDDS loaded gel to enhance the delivery of anti arthritic drug were also evaluated. Labrafil and Stelliester were used as oil phase. Cremophor used as surfactant and sodium caprylate, cutina HR pH, Lutrol Micro127, Sepitrap 4000, GMS 40-PW-(SG) as co-surfactant. Formulations were optimized using pseudoternary phase diagram. The finalized formulations (F21 and F24) and the optimized formulation F36 were characterized for various parameters. It is concluded that the research proves, the formulated SMEDDS loaded with drug has increased the solubility of poorly water soluble THDC4-0475RD and thereby increases therapeutic efficiency. It fulfilled all the required criteria of a stable SMEDDS such as globule size, size distribution, in vitro diffusion study, and in vitro anti-arthritic study. The SMEDDS gel loaded with THDC4-0475RD would be effective against arthritis through topical delivery.

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Section: Ijpsr (2018) Volume 9 Issue 3 (Research Article)mentioning

confidence: 83%

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2018

IJPSR

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“…If not possible, surgeons should be aware that patients who have undergone intensive treatment may have a higher risk for AOs. A multidisciplinary approach including hand surgeons, rheumatologists and occupational therapists is more convenient for patients and more successful in targeted disease management (33)(34)(35). Long-term follow-up of outcomes and complications need to be assessed in RA patients undergoing HSP to facilitate evidence-based decision making.…”

Section: Discussionmentioning

confidence: 99%

Adverse outcomes following hand surgery in patients with rheumatoid arthritis

et al. 2016

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R heumatoid arthritis (RA) is a systemic inflammatory and autoimmune disease characterized by inflammation in the synovial joints. It typically causes a symmetrical small-joint polyarthropathy that affects the proximal interphalangeal and metacarpophalangeal joints of the hands, wrists and feet (1). The wrist joint is often involved early in the disease course, and is regarded as one of the primary therapeutic targets because appropriate treatment prevents patient disability at work and preserves independent self-care (2). Currently, there is good evidence that early recognition of the disease and intensive treatment using disease-modifying antirheumatic drugs (DMARDs) favours improved outcomes and delays disability in RA patients (3). Nevertheless, when synovial inflammation persists over the follow-up period, joint destruction appears early and leads to rheumatic hand disease, which is characterized by deformity, dysfunction and, frequently, pain (4). Patient responses to DMARDs may be highly variable and it is currently exceedingly difficult to predict which patients will respond to which medication regimen, although current research to identify patient-specific disease signatures via genetic and proteomic approaches is ongoing. Functional and aesthetic compromise, and symptomatic complaints are the most common manifestations of the rheumatoid hand and may affect up to 70% of patients with longstanding disease (5). In such a clinical context, indications for surgery, in order of priority are: impending tendon rupture or severe nerve compression, pain relief, improved function and to correct deformity (5). Although there are clear recommendations from the National Institute for Health and Clinical Excellence (NICE) regarding early surgical referral (6), the systemic, progressive and polyarticular nature of RA elevates the complexity involved in decision-making to higher levels than is found in other areas of hand surgery. The definition of successful surgical intervention according to rheumatologists and hand surgeons varies, and has been a matter of debate for generations of physicians (7-9). Generally, rheumatologists underestimate the benefits of HSPs, while the converse is true for hand surgeons. Moreover, VM Menchaca-Tapia, EM Rodríguez, I Contreras-Yáñez, M Iglesias-Morales, V Pascual-Ramos. Adverse outcomes following hand surgery in patients with rheumatoid arthritis.

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“…The main manifestations of RA are persistent synovitis, progressive cartilage destruction, and osteoporosis. RA affects about 1% of the population, and it is associated with a large number of medical resources (Feldmann, 2002 ; Malahias et al, 2012 ; Yang et al, 2017 ). Triptolide, a diterpene epoxide, exhibits diverse pharmacological activities, including antirheumatic, analgesic, anti-inflammatory, immunosuppressive, and antitumor activities (Liu, 2011 ; Li et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Transdermal delivery of triptolide–phospholipid complex to treat rheumatoid arthritis

Liu

Pei

et al. 2021

Drug Delivery

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The aim of this study was to develop and evaluate a triptolide phospholipid complex (TPCX) for the treatment of rheumatoid arthritis (RA) by transdermal delivery. TPCX was prepared and characterized by differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FTIR) analysis, transmission electron microscope (TEM), and scanning electron microscope (SEM). The solubility of TPCX was determined. Then, a TPCX cream was prepared to evaluate its percutaneous permeability and the antiarthritis effect. The transdermal permeability was determined using the Franz method, and a microdialysis system was used for skin pharmacokinetic study. A rat model of RA was prepared to evaluate the pharmacological effects. TPCX increased the solubility of triptolide in water, and the percutaneous permeability of TPCX cream was greatly enhanced compared with triptolide cream. The skin pharmacokinetic study indicated that TPCX cream has a longer biological half-life ( t 1/2 ) and mean residence time (MRT), but it has a shorter T max than that of triptolide cream in vivo . The area under the curve (AUC 0– t )/AUC 0–∞ ) and the peak concentration ( C max ) of TPCX cream were obviously higher than those of triptolide cream. The TPCX-loaded cream alleviated paw swelling and slowed down the progression of arthritis by inhibiting the inflammatory response by down regulating the TNF-α, IL-1β, and IL-6 levels, thus exhibiting excellent antiarthritic effects. In summary, the prepared TPCX effectively increases the hydrophilicity of triptolide, which is good for its percutaneous absorption and enhances its effect on RA rats. TPCX can be a good candidate for the transdermal delivery to treat RA.

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The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

Cited by 11 publications

References 77 publications

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Adverse outcomes following hand surgery in patients with rheumatoid arthritis

Transdermal delivery of triptolide–phospholipid complex to treat rheumatoid arthritis

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