Rheumatology: Current Research
Open Access

The Role of Emerging Therapies in Rheumatology

Deborah Palmer^{* *}Correspondence: Deborah Palmer, Department of Rheumatology, North Middlesex University Hospital, London, United Kingdom, Email:

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About the Study

Rheumatology is a field of medicine that focuses on the diagnosis and treatment of autoimmune and inflammatory diseases affecting the joints and other connective tissues. Over the years, there have been significant advances in the understanding and management of rheumatic diseases. This has led to the development of emerging therapies that aim to improve patient outcomes and quality of life.

Emerging therapies

Biological therapy, also known as biologic therapy or immunotherapy, involves the use of genetically engineered proteins derived from living cells to target specific molecules involved in the inflammatory response. These drugs act by inhibiting cytokines or other molecules responsible for inflammation. They are particularly useful in the management of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

One of the most commonly used biologics is anti-Tumor Necrosis Factor (TNF) therapy. TNF is a cytokine that plays a key role in the inflammatory response. Anti-TNF drugs such as adalimumab, infliximab, and etanercept, are used to treat a range of rheumatic conditions. They are particularly effective in reducing joint inflammation, improving physical function, and preventing joint damage.

Other biologics that have been developed for the treatment of rheumatic diseases include rituximab, tocilizumab, and abatacept. Rituximab targets B cells, while tocilizumab and abatacept target Interleukin-6 (IL-6) and T cells, respectively.

Small molecule inhibitors are a class of drugs that target specific enzymes, receptors, or other proteins involved in the inflammatory response. Unlike biologics, they are small enough to be taken orally and are less expensive to produce.

One of the most commonly used small molecule inhibitors is methotrexate. Methotrexate is an antimetabolite drug that interferes with the growth and division of cells. It is used to treat rheumatoid arthritis and other autoimmune diseases. Methotrexate is often used in combination with biologics to improve treatment outcomes.

Other small molecule inhibitors that have been developed for the treatment of rheumatic diseases include Janus Kinase (JAK) inhibitors and Phosphodiesterase-4 (PDE-4) inhibitors. JAK inhibitors such as tofacitinib and baricitinib target the JAK family of enzymes, which are involved in the inflammatory response. PDE-4 inhibitors such as apremilast target phosphodiesterase-4, an enzyme that regulates the immune response.

Gene therapy is a rapidly evolving field that involves the delivery of genetic material to target cells to modify or correct abnormal genes. In rheumatology, gene therapy is being investigated as a potential treatment for autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus.

One approach to gene therapy involves the use of small interfering RNA (siRNA) to selectively silence the expression of genes involved in the inflammatory response. This approach has been used to target TNF, IL-6, and other cytokines involved in rheumatoid arthritis.

Another approach to gene therapy involves the use of Chimeric Antigen Receptor (CAR) T-cell therapy to target B cells, which are involved in the pathogenesis of rheumatoid arthritis and other autoimmune diseases. CAR T-cell therapy involves modifying a patient's T cells to express chimeric antigen receptors that can recognize and eliminate specific target cells. In rheumatoid arthritis, CAR T-cell therapy targets B cells that produce autoantibodies, which contribute to the inflammatory response.

Stem cell therapy is a promising emerging therapy in rheumatology that involves the use of stem cells to regenerate damaged tissues and modulate the immune response. Stem cells are undifferentiated cells that can differentiate into various cell types, including bone, cartilage, and immune cells. In rheumatology, stem cell therapy is being investigated as a potential treatment for osteoarthritis, rheumatoid arthritis, and systemic lupus erythematosus.

One approach to stem cell therapy involves the use of Mesenchymal Stem Cells (MSCs). MSCs have the ability to differentiate into various cell types, including bone, cartilage, and adipose tissue. They also have immunomodulatory properties, which can help to reduce inflammation and promote tissue regeneration. MSCs have been used to treat osteoarthritis, rheumatoid arthritis, and systemic lupus erythematosus with promising results.

Another approach to stem cell therapy involves the use of Hematopoietic Stem Cells (HSCs). HSCs are capable of differentiating into various immune cells, including T cells and B cells. They have been used in the treatment of autoimmune diseases such as systemic lupus erythematosus and multiple sclerosis, with promising results.