Inflammation Pharmacology Division, CSIR, Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, J&K, India; School of Biotechnology, University of Jammu, Baba Saheb Ambedkar Road, Jammu Tawi, 180006 J&K, India.
Formulation & Drug Delivery Division, CSIR, Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, J&K, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
Pharmacol Res. 2021 Jul;169:105618. doi: 10.1016/j.phrs.2021.105618. Epub 2021 Apr 18.
The use of biologically active compounds derived from plants i.e. phytochemicals, have been known for ages for their pharmacological activities in the treatment of autoimmune disorders like rheumatoid arthritis (RA). Besides enormous scientific evidence, the therapeutic potential of phytochemicals is often undervalued. The treatment in RA involves the use of synthetic and biological disease modifying anti-rheumatic drugs (DMARDs). However, the long-term treatment in RA is associated with the risk of gastrointestinal, liver, pulmonary and renal toxicities and serious infections including latent tuberculosis, pneumococcus influenza, herpes zoster and hepatitis. These adverse effects sometimes lead to discontinuation of the therapy. A relatively new vision based on the combination of DMARDs with phytochemicals exhibiting anti-inflammatory, anti-arthritic, anti-oxidant, hepatoprotective and nephroprotective properties for the treatment of RA has achieved substantial importance in the last decade. From this perspective, the present review focuses on the combination of DMARDs (primarily MTX) with phytochemicals that have shown synergistic therapeutic effects while decreasing the toxic repercussions of current RA therapy. The review covers recent evidences of such combination studies that have shown promising results both in experimental arthritic models and clinical arthritis. Few of the combinations including resveratrol, sinomenine, coenzyme Q10 exhibited considerable interest because of their efficacy as an adjuvant to the MTX/standard DMARDs therapy in clinical trials. Besides giving an overview of such combination studies the review also critically discusses the limitations with the use of phytochemicals (e.g. solubility, permeability and bioavailability) compromising their clinical application. Additionally, it stresses upon the need of novel delivery systems and pharmaceutical technologies to increase the therapeutic efficacy of the combination therapy. Overall, the review unveils the potential of phytochemicals in combination with DMARDs with increased tolerability and superior efficacy in further refining the future of the RA therapy.
植物来源的生物活性化合物（即植物化学物质）的使用，因其在治疗类风湿关节炎（RA）等自身免疫性疾病方面的药理学活性而被人们所熟知。除了大量的科学证据外，植物化学物质的治疗潜力往往被低估。RA 的治疗包括使用合成和生物疾病修饰抗风湿药物（DMARDs）。然而，RA 的长期治疗与胃肠道、肝脏、肺部和肾脏毒性以及严重感染（包括潜伏性结核病、肺炎球菌流感、带状疱疹和肝炎）的风险相关。这些不良反应有时会导致治疗中断。过去十年中，一种基于 DMARDs 与具有抗炎、抗关节炎、抗氧化、肝保护和肾保护特性的植物化学物质联合治疗 RA 的相对较新的治疗方案得到了广泛的关注。从这个角度来看，本综述重点介绍了 DMARDs（主要是 MTX）与植物化学物质的联合治疗，这些联合治疗在降低当前 RA 治疗的毒性影响的同时，显示出了协同的治疗效果。该综述涵盖了此类联合研究的最新证据，这些研究在实验性关节炎模型和临床关节炎中均显示出了有希望的结果。一些组合，包括白藜芦醇、青藤碱、辅酶 Q10，由于它们在临床试验中作为 MTX/标准 DMARDs 治疗的辅助药物的疗效，引起了相当大的兴趣。除了概述此类联合研究外，该综述还批判性地讨论了使用植物化学物质（例如溶解度、渗透性和生物利用度）的局限性，这些局限性影响了它们的临床应用。此外，它强调需要新型的给药系统和制药技术来提高联合治疗的疗效。总的来说，该综述揭示了植物化学物质与 DMARDs 联合使用的潜力，提高了耐受性和疗效，进一步完善了 RA 治疗的未来。
