ARTHRITIS.ppt

ARTHRITIS
• Family of diseases that affect the mechanical function of the articular cartilage
• chronic, degradation of articular cartilage
• Arthritis or chronic joint pain currently affects 70 million Americans - mon disease
ARTHRITIS
• each year - 44 million outpatient visits
•$22 billion in medical costs
•$82 billion total in medical costs and los productivity
ARTHRITIS
ARTHRITIS - Classes
1. Rheumatoid Arthritis
Inflammatory condition
Initially affects synovial membrane
Autoimmune disease – The body’s immune system produces inflammation and tissue damage.
Inflammatory cytokines, free radicals, prostaglandins (important in growth and repair - here too much)
Pannus ---> articular cartilage
Increases “stickiness” and reduces lubrication
Pannus
• Synovial membrane produces pannus
>> adheres to articular cartilage
• Contains abnormal proteins, blood vessels, scar tissue, collagen.
• Causes articular degradation
ARTHRITIS - Classes
Rheumatoid Arthritis
Late stages
Cartilage wears away
High friction
Bone may be exposed on bone
Disruption of periosteum and bone
Increased bone formation in joint
AND/OR
Bone degeneration
ARTHRITIS - treatment
1. Rheumatoid Arthritis
Treatment - traditional
NSAIDS (aspirin - anti-inflammatory)
COX1 inhibitors (cycoloxygenase 1 --> prostaglandins)
Cortisone (anti-inflammatory and catabolic steroid)
Gold (anti-inflammatory)
Immunosupressants (side effects)
Cyclosporin: side effects - bad for mitochondria
**Methotrexate (MTX) (used in chemotherapy) pregnancy contraindicated
Hydroxychloroquine (HCQ) - pregnancy contraindicated
ARTHRITIS - treatment
Rheumatoid Arthritis
Treatments - NEW
TNF-a inhibitors (inflammatory cytokines - regulate immune system activity; local growth at low levels)
Infliximab (antibody for TNF-a) [Remicade]
Etanercept (TNF-a inhibitor) [Enbrel]
Anakinra (IL-1ß blocker) [Kineret]
COX-2 inhibitors (Vioxx, Celebrex)
Inducible nitric oxide synthase (iNOS) inhibitors (experimental)
iNOS involved