HEMATOLOGICAL AND BIOCHEMICAL PROFILES IN RHEUMATOID ARTHRITIS PATIENTS UNDERGOING METHOTREXATE, RITUXIMAB, AND COMBINATION THERAPY
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Objective: Rheumatoid arthritis is one of the most prevalent chronically inflammation and systemically autoimmune illnesses. Non-steroidal anti-inflammatory medications (NSAIDs), corticosteroids, biological and synthetic disease-modifying antirheumatic pharmaceuticals (DMARDs), and immunosuppressive medications were all included in the guidelines for the treatment of rheumatoid arthritis. The aim of study Longitudinal assessment of WBC, Hb, platelets, ALT, AST, creatinine, urea, and ESR during taking Methotrexate (MTX) and Rituximab (RTX) treatment each alone and in combination for RA patients. Method: The study involved RA patient all taken treatment for 4 years divided into three subgroup: group (A) include 30 cases who were taken methotrexate only, group(B) include 20 cases were taken RTX only and group(C) include 10 cases who were taken combination of MTX and RTX for 4 year. In addition to the control group involved 60 healthy individuals. Results: Our findings reveal a significant decrease in hemoglobin (Hb) levels in RA patients undergoing these treatments (p=0.03) compared to controls(11.21,11.45, 11.21 ±SD vs. 12.56±0.96). Conversely, there was a significant increase in platelet counts (p=0.002) in treated RA patients (298.71 ,266.89,308.5±SD) compared to controls (248.96±51.54). No significant differences were observed in white blood cell (WBC) counts (p=0.26). Regarding kidney function, a significant increase in both creatinine (p=0.002) and urea (p=0.003) was noted in RA patients receiving treatment (0.69, 0.71, 0.8±SD for creatinine ; 28.5 26.88−32.34±SD for urea) when compared to controls (0.59±0.19 for creatinine; 24.63±5.51 for urea). However, liver function parameters, including ALP and AST, showed no significant differences (p=0.8 and p=0.15, respectively). Finally, a significant elevation in Erythrocyte Sedimentation Rate (ESR) (p=0.004) was observed in treated RA patients (35.63,52.81, 37.5 ±SD) versus the control group (17.7±8.47), indicating heightened inflammatory activity. Novelty: Longitudinal assessment of hematological, liver, kidney, and inflammatory biomarkers in RA patients over a four-year period under MTX, RTX, and combined treatment is rarely reported, especially with this specific comparative design including a healthy control group.
Y. Alamanos, P. V. Voulgari, and A. A. Drosos, “Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review,” Semin. Arthritis Rheum., vol. 36, pp. 182–188, 2006.
J. F. Marques-Neto et al., “Multicentric study of the prevalence of adult rheumatoid arthritis in Brazilian population samples,” Rev. Bras. Reumatol., vol. 33, pp. 169–173, 1993.
S. M. Verstappen et al., “A good response to early DMARD treatment of patients with rheumatoid arthritis in the first year predicts remission during follow-up,” Ann. Rheum. Dis., vol. 64, pp. 38–43, 2005.
D. Aletaha et al., “2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative,” Arthritis Rheum., vol. 62, no. 9, pp. 2569–2581, 2010.
A. K. Sailaja, “An overall review on rheumatoid arthritis,” J. Curr. Pharma Res., vol. 4, no. 2, p. 1138, 2014.
E. Nogueira, A. Gomes, A. Preto, and A. Cavaco-Paulo, “Update on therapeutic approaches for rheumatoid arthritis,” Curr. Med. Chem., vol. 23, no. 21, pp. 2190–2203, 2016.
J. S. Smolen and D. Aletaha, “Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges,” Nat. Rev. Rheumatol., vol. 11, no. 5, pp. 276–289, 2015.
J. S. Smolen et al., “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update,” Ann. Rheum. Dis., vol. 79, no. 6, pp. 685–699, 2020.
B. E. Lovisi Neto et al., “Evaluation of the efficacy of an educational program for rheumatoid arthritis patients,” Clin. Exp. Rheumatol., vol. 27, pp. 28–34, 2009.
K. Visser and D. van der Heijde, “Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: a systematic review of the literature,” Ann. Rheum. Dis., vol. 68, pp. 1094–1099, 2009.
M. Visentin, R. Zhao, and I. D. Goldman, “The antifolates,” Hematol. Oncol. Clin. North Am., vol. 26, pp. 629–648, 2012.
S. L. Whittle and R. A. Hughes, “Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review,” Rheumatology (Oxford), vol. 43, pp. 267–271, 2004.
B. S. Lian, I. Busmanis, and H. Y. Lee, “Relapsing course of sulfasalazine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) complicated by alopecia universalis and vitiligo,” Ann. Acad. Med. Singap., vol. 47, no. 11, pp. 492–493, Nov. 2018.
S. L. Morgan et al., “Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis: a double-blind, placebo-controlled trial,” Ann. Intern. Med., vol. 121, no. 11, pp. 833–841, 1994.
E. Keystone et al., “Safety and efficacy of additional courses of rituximab in patients with active rheumatoid arthritis: an open-label extension analysis,” Arthritis Rheum., vol. 56, pp. 3896–3908, 2007.
M. H. Buch et al., “Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis,” Ann. Rheum. Dis., vol. 70, pp. 909–920, 2011.
P. Koźmiński, P. K. Halik, R. Chesori, and E. Gniazdowska, “Overview of dual-acting drug methotrexate in different neurological diseases, autoimmune pathologies and cancers,” Int. J. Mol. Sci., vol. 21, no. 10, p. 3483, 2020.
M. Hoekstra et al., “Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis,” Ann. Rheum. Dis., vol. 62, no. 5, pp. 423–426, 2003.
L. Genestier, R. Paillot, L. Quemeneur, K. Izeradjene, and J. P. Revillard, “Mechanisms of action of methotrexate,” Immunopharmacology, vol. 47, no. 2–3, pp. 247–257, 2000.
C. Salliot and D. Van der Heijde, “Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research,” Ann. Rheum. Dis., vol. 68, pp. 1100–1104, 2009.
A. M. Buhroo and A. N. Baba, “Adverse effects of low dose methotrexate in patients with rheumatoid arthritis,” Indian J. Phys. Med. Rehabil., vol. 17, pp. 21–25, 2006.
R. Sotoudehmanesh et al., “Methotrexate hepatotoxicity in patients with rheumatoid arthritis,” Middle East J. Dig. Dis., vol. 2, pp. 104–109, 2010.
S. Prey and C. Paul, “Effect of folic or folinic acid supplementation on methotrexate-associated safety and efficacy in inflammatory disease: a systematic review,” Br. J. Dermatol., vol. 160, pp. 622–628, 2009.
Z. Wang et al., “Evaluating the effect of methotrexate on the rate of renal fibrosis by elastography and fibrosis-related gene expression,” Cell. Mol. Biol., vol. 67, no. 6, pp. 291–297, 2021.
J. Higashida et al., “Safety and efficacy of rituximab in patients with rheumatoid arthritis refractory to disease modifying antirheumatic drugs and anti-tumor necrosis factor-alpha treatment,” J. Rheumatol., vol. 32, no. 11, pp. 2109–2115, 2005.
M. Zisapel, D. Paran, and O. Elkayam, “Rituximab in rheumatoid arthritis-therapeutic aspects based on 18 years of global experience,” Harefuah, vol. 158, no. 9, pp. 595–600, 2019.
K. C. Wang et al., “Real‐world effectiveness and safety of rituximab in the treatment of rheumatoid arthritis: A single‐center experience in Taiwan,” Int. J. Rheum. Dis., vol. 22, no. 5, pp. 860–868, 2019.
J. C. Edwards et al., “Efficacy of B-cell–targeted therapy with rituximab in patients with rheumatoid arthritis,” N. Engl. J. Med., vol. 350, no. 25, pp. 2572–2581, 2004.
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