A multidisciplinary team approach (i.e. including various medical professions such as specialist nurses, physiotherapists, professional therapists, and pediatricians) is often used to treat patients with various rheumatological diseases. The patient can also be an active member of the team to handle and manage all aspects of care. In this article, we consider the treatment of rheumatological diseases, their history, and modern approaches.
Nonsteroidal anti-inflammatory drugs (NSAIDs), the disease-modifying antirheumatic drugs, corticosteroids, monoclonal antibodies. And also new biological agents are drugs used in the treatment of rheumatological diseases. Despite the great success in the chemotherapeutic approach, physiotherapy remains an important tool in the treatment of rheumatic diseases.
Treatment of rheumatological diseases
In ancient times, various methods of treatment were used for rheumatic diseases. Hippocrates and Galen advocated barley water and barley bread for gout, as well as laxative therapy for cases of chronic gout. Emperor Augustus successfully used the diet to treat his rheumatism, and also applied various forms of spa therapy.
The use of urinary agents to treat gout began in the late 19th century. All of them need good renal function in order to be effective. And the drug, called probenecid, is a means of choice for today. Allopurinol was the first xanthine oxidase inhibitor to be used successfully in the treatment of gout in 1963.
The most important milestone in rheumatology was the treatment of rheumatoid arthritis with glucocorticoids in 1948. Although they were originally used in high doses for short-term treatment of outbreaks, treatment with a low dose of glucocorticoids (less than 10 mg per day) has long-term disease-modifying effects.
Another milestone occurred in 1968 when methotrexate folate antagonist was first used in the treatment of dermatomyositis. Since then, methotrexate, administered in low doses, has become the main drug for the treatment of many rheumatic diseases due to its effectiveness and low toxicity.
It was shown that various antimalarial drugs are effective for rheumatological conditions since quinine was first used to treat systemic lupus erythematosus more than a hundred years ago. Three antimalarial drugs are now used to treat connective tissue diseases: chloroquine, hydroxychloroquine, and quinacrine.
Modern therapeutic approaches
The development of biological therapy has changed the way rheumatoid arthritis is treated. Because they are able to improve results when non-biological treatments have failed to achieve adequate disease control. Antibodies directed against specific cell types and certain proinflammatory cytokines involved in autoimmune reactions represent the success of rational research programs in rheumatology.
A modern approach to the treatment of gout means that not only acute attacks are controlled, but also urate-lowering therapy increases the titer against the target level of serum uric acid, which is below the saturation point for the formation of crystals. Current prospects are shifting towards earlier use of therapy, which reduces the level of urate, even during the first diagnosis.
Non-pharmacological therapies, such as patient education, weight loss, and exercise, are still the cornerstone of osteoarthritis treatment. But because of the chronic nature of the disease, long-term medication is often necessary.
The introduction of biological agents that modify diseases (for example, infliximab) has undoubtedly become a landmark event in the treatment of rheumatological diseases. However, such biological treatments bring new challenges, namely the high cost of development, which should be included in the price of medicines. And accordingly, it makes these treatments very expensive compared to non-biological treatments.