Abstract
The most common treatments for rheumatoid arthritis include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease modifying antirheumatic drugs (DMARDs), and some biological agents. However, none of the treatments available is able to achieve the ultimate goal of treatment, that is, drug-free remission. This limitation has shifted the focus of treatment to delivery strategies with an ability to deliver the drugs into the synovial cavity in the proper dosage while mitigating side effects to other tissues. A number of approaches like microemulsions, microspheres, liposomes, microballoons, cocrystals, nanoemulsions, dendrimers, microsponges, and so forth, have been used for intrasynovial delivery of these drugs. Amongst these, liposomes have proven to be very effective for retaining the drug in the synovial cavity by virtue of their size and chemical composition. The fast clearance of intra-synovially administered drugs can be overcome by use of liposomes leading to increased uptake of drugs by the target synovial cells, which in turn reduces the exposure of nontarget sites and eliminates most of the undesirable effects associated with therapy. This review focuses on the use of liposomes in treatment of rheumatoid arthritis and summarizes data relating to the liposome formulations of various drugs. It also discusses emerging trends of this promising technology.
Highlights
Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease that affects the multiple joints of the body in a symmetric pattern [1, 2]
There is no cure of RA and it is most commonly treated with a combination of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease modifying antirheumatic drugs (DMARDs), and biological agents [13,14,15,16]
An inflammation of the joints, is a chronic disease that results from dysregulation of proinflammatory cytokines and proinflammatory enzymes that mediate the production of prostaglandins and leukotrienes, together with the expression of adhesion molecules and matrix metalloproteinase, and hyperproliferation of synovial fibroblasts
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease that affects the multiple joints of the body in a symmetric pattern [1, 2] It is characterised by chronic inflammation of synovial membrane which often leads to destruction of articular cartilage, periarticular bone erosion, and permanent deformities. The precise etiology of RA is not known, but it is evident that proinflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and transforming growth factor-β (TGF-β) play an important role in pathogenesis of disease [10] These inflammatory cytokines are released by synovial macrophages, B cells, fibrocytes, synoviocytes, CD4+, and CD8+ T cells and can be detected in the synovium immunohistochemically [11]. The current review presents a detailed discussion about various agents used for the treatment of RA and the potential of novel drug delivery systems, liposomes, to achieve successful delivery of these agents
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