The anti-TNF-a therapy in de rheumatoid arthritis

Abstract

Rheumatoid arthritis is a chronic, systemic autoimmune disease of unknown etiology that involves predominantly synovial articulations, which can lead to deformity and destruction. With the progression of the disease, patients with Rheumatoid Arthritis develop inability to perform activities of daily living both as a professional, generating a significant economic impact for the patient and to society. Although the exact cause of rheumatoid arthritis remains unknown, studies conducted over the past two decades has enabled greater understanding of the pathogenesis of this disease. This knowledge has allowed the development of new therapies used to treat severe forms of the disease. The main goal of treatment is to achieve remission, however, when this can not be expected to prevent joint damage and loss of function and even reduce pain. The latest strategies for the treatment of Rheumatoid Arthritis involve the early diagnosis and aggressive control of inflammation. The recognition of pro-inflammatory cytokines expressed more as tumor necrosis factor ? (TNF-?) and interleukin (IL) 1 and IL6 enabled developing new therapies directed against these cytokines targets. TNF-? is a proinflammatory cytokine that plays a key role in immune response, defense against microorganisms and the inflammatory process. Biological agents that inhibit TNF-? are considered effective in reducing activity and in the retardation of structural joint damage in rheumatoid arthritis, especially in forms refractory to conventional treatments. Currently, they are available in Brazil, three anti-TNF-?: infliximab, etanercept and adalimumab. These drugs are relatively safe for Rheumatoid Arthritis, but may, however, present serious infectious complications such as reactivation of latent tuberculosis.The high cost of these drugs, their use in hospital and the risk to opportunistic infections remain the limiting factors for its widespread use in the treatment of Rheumatoid Arthritis in our midst. This study aims at highlighting the importance of the emergence of new therapies in order to attenuate the progression of rheumatoid arthritis, and to analyze risk-benefit offered by their treatment and assess the feasibility and cost of the same.