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Antirheumatic – Agents, Effects and Therapies

Antirheumatic refers to substances, therapies, or measures used to treat rheumatic diseases, helping to reduce inflammation, relieve pain, and slow disease progression.

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Things worth knowing about "Antirheumatic"

Antirheumatic refers to substances, therapies, or measures used to treat rheumatic diseases, helping to reduce inflammation, relieve pain, and slow disease progression.

What Does Antirheumatic Mean?

The term antirheumatic describes anything used to treat or alleviate rheumatic diseases. This includes medications, physical therapies, and complementary measures that inhibit inflammation, reduce pain, and positively influence the course of disease. Rheumatic diseases affect the musculoskeletal system, connective tissues, and the immune system.

Overview of Rheumatic Diseases

Rheumatism is not a single condition but an umbrella term covering more than 400 different diseases. The most common forms include:

Rheumatoid arthritis: A chronic inflammatory joint disease with an autoimmune component.
Osteoarthritis: Degenerative joint disease caused by cartilage breakdown.
Gout: An inflammatory joint condition caused by elevated uric acid levels.
Lupus erythematosus: A systemic autoimmune disease with widespread inflammatory reactions.
Ankylosing spondylitis: A chronic inflammatory disease of the spine.

Antirheumatic Agents and Mechanisms of Action

Antirheumatic substances can be divided into several groups based on their mechanism of action and clinical use:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs such as ibuprofen, diclofenac, and naproxen inhibit cyclooxygenase enzymes (COX-1 and COX-2), thereby reducing the production of prostaglandins. These signaling molecules play a key role in inflammation and pain. NSAIDs act as anti-inflammatory, analgesic, and antipyretic agents.

Glucocorticoids

Cortisone and its derivatives (e.g., prednisolone) are highly effective antirheumatic agents. They broadly suppress the immune system by inhibiting inflammatory mediators and are used during acute flares of rheumatic diseases. Due to potential long-term side effects, they are generally used short-term or at low maintenance doses.

Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs target the underlying disease process and slow disease progression. This group includes:

Conventional DMARDs: e.g., methotrexate, hydroxychloroquine, sulfasalazine.
Biologics: Biotechnologically produced antibodies or receptor blockers, e.g., TNF-alpha inhibitors (adalimumab, etanercept), IL-6 inhibitors (tocilizumab).
JAK inhibitors: Targeted synthetic DMARDs that inhibit Janus kinases (e.g., baricitinib, tofacitinib).

Herbal Antirheumatic Agents

Certain plant extracts have demonstrated antirheumatic properties, including:

Devil's claw (Harpagophytum procumbens): Contains harpagoside, which has anti-inflammatory effects.
Willow bark: Contains salicin, a precursor of acetylsalicylic acid.
Curcumin: The active compound in turmeric, with proven anti-inflammatory activity.
Omega-3 fatty acids: Reduce the production of pro-inflammatory eicosanoids.

Antirheumatic Treatment Measures

In addition to pharmacological treatment, non-drug approaches play an equally important role:

Physiotherapy: Maintains joint mobility and strengthens surrounding muscles.
Occupational therapy: Adapts daily activities and introduces assistive devices.
Cold and heat therapy: Used for pain relief and inflammation reduction.
Hydrotherapy: Water-based treatments to improve circulation and mobility.
Dietary adjustments: An anti-inflammatory diet such as the Mediterranean diet can support treatment.

Treatment Goals

The goals of antirheumatic therapy are to control inflammation, relieve pain, preserve joint function, and sustainably improve the quality of life of those affected. In chronic conditions such as rheumatoid arthritis, long-term -- often lifelong -- treatment is necessary. Therapy should always be individually tailored and supervised by a specialist in rheumatology.

References

Smolen J. S. et al. - EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Annals of the Rheumatic Diseases, 2023.
Firestein G. S. et al. - Kelley's and Firestein's Textbook of Rheumatology, 11th Edition. Elsevier, 2020.
World Health Organization (WHO): Chronic rheumatic conditions. Available at: https://www.who.int/chp/topics/rheumatic/en/

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