Rheumatoid arthritis: Pathophysiology, treatment and improved efficacy of targeted treatment using novel herbal therapeutics formulations

Arshvir Kaur
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Abstract

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease that leads to synovial inflammation, destruction of articular cartilage, bone erosion, deformities, accompanied by pain, swelling, and stiffness, most commonly in limbs. The pathophysiology elaborates on the role of T-helper (Th1) cells secreted in response to interleukin-1 (IL-1) and 12, thus producing pro-inflammatory ILs whereas Th2 cells activated by IL-4 secretes anti-inflammatory cytokines (IL-4, 5, 10 and 13). A neutralization of endogenous anti-inflammatory cytokines mainly IL-10 by the production of anti-IL-10 monoclonal antibodies, results in the downregulation of antiinflammatory cytokines which lead to more severe collagen-induced arthritis. Conventional treatment for RA includes non-steroidal anti-inflammatory drugs, glucocorticoids, non-biologics, and biological disease-modifying anti-rheumatic drugs, a conjugate of the humanized monoclonal antibody, dendritic cells, etc. Although, conventional therapy and newer treatments are effective but suffer from several limitations like serious adverse effects, high cost, and invasive intervention. The information regarding disease, pathophysiology, treatment, and novel interventions was collected through vigorous literature search from authentic search engines, books and journals using relevant keywords. Novel herbal therapies using phytochemicals of Curcuma longa, Zingiber officinale, Glycyrrhiza glabra, Withania somnifera, Tripterygium wilfordii, Boswellia serrata, Camellia sinensis, Tanacetum parthenium, Commiphora wightii, Mukul, Plumbago zeylanica through their promising novel drug delivery systems like microspheres, transdermal patches, ethosomes, liposomes, and phytosomes. have shown promising response and efficacy via well-defined immune mechanism along with their easy accessibility, mild or negligible adverse effects, thus gaining the edge over conventional and invasive therapies for RA. This review indicates that there is a need to study these novel formulations, extensively on preclinical and clinical levels and develop these herbal therapies as a promising alternative to conventional therapies for the treatment of RA.
类风湿关节炎:病理生理,治疗和使用新型草药治疗制剂靶向治疗的疗效改善
类风湿性关节炎(RA)是一种慢性炎症性自身免疫性疾病,可导致滑膜炎症、关节软骨破坏、骨侵蚀、畸形,并伴有疼痛、肿胀和僵硬,最常见于四肢。病理生理学详细阐述了响应白细胞介素-1 (IL-1)和12分泌的t辅助细胞(Th1)的作用,从而产生促炎的il,而被IL-4激活的Th2细胞分泌抗炎细胞因子(IL-4、5、10和13)。通过产生抗IL-10单克隆抗体来中和内源性抗炎细胞因子,主要是IL-10,导致抗炎细胞因子的下调,从而导致更严重的胶原诱导关节炎。RA的常规治疗包括非甾体类抗炎药、糖皮质激素、非生物制剂、生物疾病修饰抗风湿药、人源化单克隆抗体偶联物、树突状细胞等。虽然传统疗法和新疗法是有效的,但也存在副作用严重、费用高、侵入性等局限性。通过使用相关关键词从真实的搜索引擎、书籍和期刊中进行大量文献检索,收集有关疾病、病理生理、治疗和新型干预措施的信息。利用姜黄、生姜、光甘草、苦参、雷公藤、乳香、山茶花、牛膝草、白沙草、白沙草等植物化学物质,通过微球、透皮贴剂、脂质体、磷脂质体等有前途的新型给药系统,开发出新的草药疗法。通过明确的免疫机制以及其易于获取,轻微或可忽略的不良反应,显示出良好的反应和疗效,从而获得优于常规和侵入性治疗RA的优势。这一综述表明,有必要在临床前和临床水平上广泛研究这些新配方,并开发这些草药疗法,作为治疗RA的传统疗法的有希望的替代疗法。
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