What are inflammatory diseases and their treatments?

From the Guidelines

Inflammatory diseases are conditions characterized by abnormal immune system responses that cause inflammation in various body tissues, including rheumatoid arthritis, inflammatory bowel disease (Crohn's disease and ulcerative colitis), psoriasis, asthma, and multiple sclerosis. The most recent and highest quality study on this topic is from 2023, which discusses the use of ozanimod for the treatment of ulcerative colitis 1. According to this study, treatment typically involves anti-inflammatory medications, starting with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for mild cases. Some key points to consider when treating inflammatory diseases include:

• Corticosteroids such as prednisone (5-60mg daily depending on severity) may be used for moderate to severe inflammation, though long-term use requires careful monitoring due to side effects.
• Disease-modifying antirheumatic drugs (DMARDs) like methotrexate (7.5-25mg weekly) and biologics such as TNF inhibitors (adalimumab, infliximab) target specific immune pathways for conditions like rheumatoid arthritis.
• Lifestyle modifications including anti-inflammatory diets rich in omega-3 fatty acids, regular exercise, stress management, and adequate sleep complement medication therapy.
• Treatment plans must be individualized based on the specific condition, severity, and patient factors, with the goal of reducing inflammation, preventing tissue damage, managing symptoms, and improving quality of life. Another study from 2021 discusses the management of patients with inflammatory bowel disease-associated spondyloarthritis, and provides recommendations for treatment based on a pseudo-Delphi consensus 1. Additionally, a study from 2021 provides points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors, which are a new class of targeted synthetic DMARDs that interfere with signal transduction pathways of a variety of cytokines 1. Overall, the treatment of inflammatory diseases requires a comprehensive approach that takes into account the specific condition, severity, and patient factors, and aims to reduce inflammation, prevent tissue damage, manage symptoms, and improve quality of life.

From the FDA Drug Label

In rheumatoid arthritis, treatment with infliximab products reduced infiltration of inflammatory cells into inflamed areas of the joint as well as expression of molecules mediating cellular adhesion [E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)], chemoattraction [IL-8 and monocyte chemotactic protein (MCP-1)] and tissue degradation [matrix metalloproteinase (MMP) 1 and 3]. In Crohn's disease, treatment with infliximab products reduced infiltration of inflammatory cells and TNFα production in inflamed areas of the intestine, and reduced the proportion of mononuclear cells from the lamina propria able to express TNFα and interferon Elevated concentrations of TNFα have been found in involved tissues and fluids of patients with rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis

The inflammatory diseases mentioned are:

• Rheumatoid arthritis
• Crohn's disease
• Ulcerative colitis
• Ankylosing spondylitis
• Psoriatic arthritis
• Plaque psoriasis 2

From the Research

Inflammatory Diseases

Inflammatory diseases are a group of conditions characterized by dysregulation of the normal immune response, leading to inflammation. Examples of inflammatory diseases include:

• Rheumatoid arthritis (RA) 3, 4, 5
• Psoriasis 3, 4
• Crohn's disease 3, 4, 6
• Ulcerative colitis 4
• Systemic lupus erythematosus (SLE) 4, 6
• Ankylosing spondylitis 6
• Psoriatic arthritis 6

Treatments for Inflammatory Diseases

Various treatments are available for inflammatory diseases, including:

• Methotrexate (MTX), a first-line treatment for RA, psoriasis, and Crohn's disease 3, 5
• Biologic agents targeting the T-helper 17 axis, such as secukinumab and ixekizumab 4
• Janus kinase (JAK) inhibitors, such as tofacitinib and baricitinib 4
• Biologics active against type I and II interferons, such as sifalumumab and rontalizumab 4
• Emerging strategies to interfere with cellular adhesion processes, such as integrin blockade and sphingosine-1-phosphate receptor inhibition 4
• Natural products with anti-inflammatory properties, which may provide new opportunities for treating diseases associated with chronic inflammation 7

Role of Chronic Inflammation in Various Diseases

Chronic inflammation is implicated in the development and progression of various diseases, including:

• Cardiovascular diseases 7
• Respiratory diseases 7
• Metabolic diseases 7
• Neurodegenerative diseases 7
• Cancers 7 Understanding the role of chronic inflammation in these diseases may help identify potential novel therapeutic targets and facilitate the development of new treatments.