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QUESTION
Title: rheumatoid arthritis: Risk/benefits of latest treatment
Paper Details
For this review, be sure to:
Select three relevant and appropriate scholarly articles that address the topic you chose.
Present a thorough literature review of the three articles by summarizing, synthesizing, and evaluating the materials.
Incorporate citations into your body paragraphs; incorporate the essential and most relevant supporting evidence eloquently and appropriately.
Present your writing in a clear, organized manner.
Demonstrate understanding of the content presented in the articles.
Use proper APA format with proper citations. Review APA Citations Here
Subject | Nursing | Pages | 5 | Style | APA |
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Answer
Over the past two decades or so, new ways regarding the treatment of inflammatory rheumatism have emerged. Through research, scientists have gained knowledge regarding immunology, genetics, as well as molecular and cellular biology, which is now showing vital results in the treatment of the disease. In particular, the management of rheumatoid arthritis has experienced significant transformation given that the disease is one of the most dangerous forms of the condition. This is because it can damage as well as rupture tendons that hold muscle and severe cases may require reconstruction of tissues. The latest treatment involves biologics and the use of the disease-modifying antirheumatic drug (DMARDs). New subcategories under this approach include JAK inhibitors (Janus Kinase), which represents a novel way designed to block JAK pathways that are part of the body’s immune reaction. Similar to previous treatment methods, the latest ways are attributed to risks and benefits.
Biologics have increasingly become part of the latest treatment of rheumatoid arthritis because of the benefits they present. According to Scott (2011), the success attributed to this method underline the vital role of cytokines in the pathogenesis of inflammatory types of the disease. Furthermore, biologics are responsible for increased concentration on T as well as B cells. It must be known that cytokines represent relatively large peptides that can be inhibited only by considerably large molecules. The biologics involved in inhibiting cytokines are proteins that are based immunoglobulins. In the case of inflammatory arthritis, the biologics used in current treatment approaches are genetically engineered proteins that are derived out of human genes. Primarily, they are utilized in inhibiting specific components regarding the immune system to ensure they do not contribute in aggravating inflammation in the disease. Dissimilar to conventional drugs that were intended to modify the entire immune system of a sufferer, biologics present added advantages in that they are specifically targeted all of which increased efficacy concerning the likelihood of adverse effects.
Regarding benefits, Mocsai, Kovacs, and Gergely (2014) add that biologics as one of the latest treatment options for rheumatoid arthritis introduces established long-term efficacy. For instance, anti-TNF therapy considerably enhances the disease activity of rheumatoid arthritis in virtually all the patients, which is a welcome effect over traditional DMARDs. The authors report the approximately half of the patients treated using biologics can reach the desired level of remission of rheumatoid arthritis. Also, the advantages associated with the treatment method last up to five years in many patients. This also includes biologics’ ability to reduce and in some cases stop the radiographic development of the disease. Furthermore, biologic-based therapies are increasingly suited to patients with previously known health conditions that made conventional treatments complicated altogether. As an example, Mocsai, Kovacs, and Gergely (2014) note that the latest methods used to treat rheumatoid arthritis are suitable for individuals with renal impairment. This is because hitherto there is no difference observed in the pharmacokinetics of etanercept between people with normal renal function and patients on hemodialysis.
Another advantage involves biologics’ suitability for individualized therapy. Considering that rheumatoid arthritis is similar to other autoimmune rheumatic diseases regarding its heterogeneous nature as far as response is concerned, the identification biomarkers means potential to predict the reaction to a particular agent. Mocsai, Kovacs, and Gergely (2014) observe that biomarkers such as genetic polymorphisms as well as levels of autoantibodies may be utilized in the identification of populations that have an optimal response to biologics. The implication is that the current treatment means cases of rheumatoid arthritis are addressed individually and thus raising the likelihood of positive outcomes. In particular, new treatment methods require a comprehensive understanding of a single case regarding autoimmunity as well as inflammation at the molecular level. Other benefits associated with this latest treatment technique include preserving the functional status of a patient’s joints, reduction in fatigue, control of manifestations of extra-articular such as accelerated atherosclerosis and preserve the ability of sufferer to work. The advantages have been proven to persist during a number of years of follow-up all of which suggest that the latest rheumatoid arthritis treatment options are cost-effective.
Several risks are also linked to the current treatment methods. According to Yoo (2014), risks currently raised against biologics include efficacy, the safety profile of the products including immunogenicity, interchangeability, as well as long-term effects. In particular, there is concern regarding safety over whether immunogenicity influences the adverse events, hypersensitivity, injection site reaction, and pharmacokinetic profile. Yoo (2014) claims that recent findings demonstrate there is no further rise in the anti-drug antibody positive level following six months of treatment. The suggestion is that the efficacy of the new treatment methods is doubtful even as some studies present data showing otherwise. Positive results after the administration of biologic treatment may not always be expected, and potential adverse reactions may be witnessed. Regarding the areas of switching and interchangeability, Yoo (2014) posits that the most pressing question include loss of efficacy and the emergence of a hypersensitivity response following switching. Crucially, evidence in this vital aspect of new drugs is lacking. Yoo (2014) further says that switching from the originator infliximab through biosimilar CTP-13 has demonstrated efficacy maintenance as well as comparable safety for just a year. Rather than repeating comprehensive clinical studies, it is necessary that pharmaco-vigilance research with a registry in different approved indications is undertaken. The aim is to guarantee the long-term efficacy of biologics and reduce potential risks. Yoo (2014) says that regulatory bodies such as the European Medicines Agency among others recommend such activities. What is more, whereas the significantly lower cost associated with biologic agents represent an advantage there is a risk of overriding safety as well as efficacy. To this end, it is imperative that a proper pharmacoeconomic analysis is undertaken to clarify the manner in which the price of this treatment is cost-effective. Such concerns are evident as Yoo (2014) cites that biologic agents may seem superior regarding radiologic progression but not when clinical outcome measures at more than one year are introduced.
In sum, current treatment methods concerning rheumatoid arthritis represent significant gains in the field of medicine. More so, they are associated with several benefits that have been hailed as groundbreaking because of the gains supposedly achieved by a patient. For instance, the emerging techniques are increasingly individualized all of which suggest to a likelihood of improved outcomes. Biologics are also attributed to other advantages including reduced side-effects such as fatigue as well as the ability of these drugs to preserve a sufferer’s working capacity. Even as the developments in rheumatoid arthritis are celebrated, there are glaring risks including concerns over efficacy and safety. Some studies suggest that comprehensive research is needed to demonstrate the effectiveness of the treatment techniques in the long-term.
References
Mocsai, A., Kovacs, L., & Gergely, P. (2014). What is the future of targeted therapy in rheumatology: biologics or small molecules? BMC Medicine, 12(43), p. 1-9. Scott, D. (2011). Biologics-Based Therapy for the Treatment of Rheumatoid Arthritis. Clinical pharmacology & Therapeutics, 91(1), p. 30-44. Yoo, D. h. (2014). The rise of biosimilars: potential benefits and drawbacks in rheumatoid arthritis. Expert Review of Clinical Immunology, 10(8), p. 981-983.
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