Pathogenesis and Current Treatment Strategies in Rheumatoid Arthritis: A Systematic Review Article

Area of Science:

• Immunology
• Rheumatology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting 0.5%-1% of adults in developed regions.
• RA leads to progressive joint destruction, including cartilage and bone erosion, causing deformities and pain.
• Inflammatory cytokines and proteinases, such as matrix metalloproteinases (MMPs), perpetuate joint damage in RA.

Purpose of the Study:

• To discuss the challenges and administration routes of monoclonal antibodies (mABs) for treating RA.
• To highlight the pharmacokinetic considerations for parenteral administration of mABs.
• To explore alternative administration routes for biologic therapies in RA management.

Main Methods:

• Review of existing literature on RA pathophysiology and treatment.
• Analysis of monoclonal antibody (mAB) pharmacokinetics and bioavailability.
• Discussion of parenteral administration routes including intravenous, intramuscular (IM), and subcutaneous (SC) injections.

Main Results:

• Monoclonal antibodies (mABs) exhibit poor oral bioavailability (<1%) due to limited membrane permeability and gastrointestinal instability.
• Parenteral administration, primarily subcutaneous (SC), is preferred for mABs, despite slower absorption and potential degradation.
• Peak plasma concentrations for SC/IM administered mABs are typically achieved 3-7 days post-administration.

Conclusions:

• Subcutaneous (SC) administration is the most common route for monoclonal antibodies (mABs) in RA treatment due to convenience and self-administration potential.
• Understanding the absorption dynamics of SC/IM injections is crucial for optimizing RA therapy with mABs.
• Further research into alternative administration routes may improve therapeutic outcomes for RA patients.