Biological therapy of rheumatic diseases

The ineffectiveness of „disease-modifying“ drugs in a proportion of patients with inflammatory arthropathies and inconclusive results

of studies investigating radiological progression have accelerated the efforts to develop new, more effective pharmaceuticals with an

aim to affect not only clinical activity but also radiological progression. The development of these new pharmaceuticals is based on the

knowledge of the key roles of T and B lymphocytes and cytokines produced by activated immunocompetent cells in the pathogenesis

of inflammatory arthropathies. The most significant cytokines include tumor necrosis factor alpha (TNFα), interleukin-1 (IL-1), and

interleukin-6 (IL-6). This knowledge has led to the development of substances specifically designed to inhibit these cells and/or their

cytokines, primarily TNFα. Treatment with these pharmaceuticals has proved highly effective in rheumatoid arthritis resistant to treatment

with standard „disease-modifying“ drugs in virtually all available parameters followed. Similarly positive experience has been

gained with the treatment of spondylarthritides, particularly psoriatic arthritis and ankylosing spondylitis. Currently, three substances

inhibiting TNFα are available: infliximab (REMICADE), etanercept (ENBREL), and adalimumab (HUMIRA). Further research in this field

has led to the development of pharmaceuticals affecting T cell activation at the level of so-called costimulatory molecules (so-called

immunomodulators such as abatacept). Another approach to „biological therapy“ is represented by an effort to affect activation of

B cells that also play a role in the genesis of rheumatoid arthritis (rituximab).

Keywords: biological therapy, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, TNFa, cytokines.