The Study on P-Glycoprotein Expression on Peripheral Lymphocytes of Refractory Rheumatoid Arthritis Patients

2018 ◽  
Vol 8 (6) ◽  
pp. 911-914
Author(s):  
Xueming Yao ◽  
Wukai Ma ◽  
Ying Huang ◽  
Qiaoyi Ning ◽  
Lei Hou ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Peripheral Lymphocytes ◽  
P Glycoprotein ◽  
Refractory Rheumatoid Arthritis

scholarly journals Tacrolimus, a Calcineurin Inhibitor, Overcomes Treatment Unresponsiveness Mediated by P-glycoprotein on Lymphocytes in Refractory Rheumatoid Arthritis

2010 ◽  
Vol 37 (3) ◽  
pp. 512-520 ◽  
Author(s):  
KATSUNORI SUZUKI ◽  
KAZUYOSHI SAITO ◽  
SHIZUYO TSUJIMURA ◽  
SHINGO NAKAYAMADA ◽  
KUNIHIRO YAMAOKA ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Calcineurin Inhibitor ◽  
Mononuclear Cells ◽  
Early Response ◽  
Inhibitory Effect ◽  
Peripheral Blood Mononuclear ◽  
P Glycoprotein ◽  
Refractory Rheumatoid Arthritis ◽  
Cell Medium ◽  
Mdr 1

Objective.Tacrolimus, a calcineurin inhibitor, is used for treatment of rheumatoid arthritis (RA). It also inhibits functions of P-glycoprotein, which is involved in drug resistance. We examined the mechanisms of early response to 2-week tacrolimus treatment in patients with RA.Methods.One hundred thirteen patients with refractory RA despite at least 3 antirheumatic agents, including methotrexate, were treated with tacrolimus (1.5–3 mg/day) and the response was assessed at 2 weeks. Expression of the multidrug resistance (MDR-1) gene and P-glycoprotein was assessed in peripheral blood mononuclear cells (PBMC) collected from 113 patients and 40 healthy subjects. The drug exclusion function by the P-glycoprotein was measured by the residual amount of intracellular tritium-labeled dexamethasone cell/medium ratio (C/M ratio).Results.The disease activity of enrolled patients was 5.8 ± 1.2 (mean ± SD) by DAS28 erythrocyte sedimentation rate. A good response to tacrolimus was noted at 2 weeks in 22 of 113 patients. At baseline, PBMC of patients with RA showed upregulated expression ofMDR-1gene and P-glycoprotein and low C/M ratio. The response to tacrolimus correlated with P-glycoprotein expression and C/M ratio. A significant improvement in C/M ratio was noted after 2 weeks of treatment. The C/M ratio correlated significantly with P-glycoprotein expression on CD4+ lymphocytes.Conclusion.Early efficacy of tacrolimus treatment depended on its inhibitory effect on the drug exclusion function of P-glycoprotein, leading to restoration of intracellular therapeutic levels of corticosteroids and clinical improvement. Evaluation of P-glycoprotein expression on lymphocytes is potentially useful for predicting the response to RA treatment.

Fatal pneumocystis carinii pneumonia as a complication of methotrexate in rheumatoid arthritis

2003 ◽  
Vol 2 (1) ◽  
pp. 25-26
Author(s):  
M Suleman ◽  
◽  
MB Chaudri ◽  
C Deighton ◽  
RB Hubbard ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Female Patient ◽  
Pneumocystis Carinii Pneumonia ◽  
Low Dose ◽  
Opportunistic Infections ◽  
Pneumocystis Carinii ◽  
Dose Methotrexate ◽  
Refractory Rheumatoid Arthritis ◽  
Healthy Female

Low dose methotrexate has been used successfully to treat patients with refractory rheumatoid arthritis.1 Methotrexate-induced pneumonitis occurs in about 1 to 5% of patients, although opportunistic infections have also been reported.1 We report a case of fatal pneumocystis carinii pneumonia (PCP) in an otherwise healthy female patient treated with methotrexate for rheumatoid arthritis and review the literature.

scholarly journals Intermittent cyclophosphamide in refractory rheumatoid arthritis.

BMJ ◽  
1983 ◽  
Vol 287 (6394) ◽  
pp. 711-712 ◽  
Author(s):  
K Horslev-Petersen ◽  
J M Beyer ◽  
P Helin
Keyword(s):  
Rheumatoid Arthritis ◽  
Refractory Rheumatoid Arthritis
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