Summary & Conclusion
Rheumatoid arthritis is a chronic, relapsing inflammatory and autoimmune multisystem illness that affects the joints. The early recognition and treatment of RA is important to minimize disability and maximize quality of life.
Methotrexate is a potent antimetabolite inhibiting purine synthesis enzyme dihydro folate reductase, which subsequently inhibits de-novo purine and pyrimidine synthesis. It is known that it is the cornerstone of disease-modifying treatment in patients with RA.
Fluoxetine is a selective serotonin reuptake inhibitor that has been widely used for the treatment of depression due to is safer profile, fewer side effects, and greater tolerability compared to other many antidepressants. Studies have found the following important functions of fluoxetine related to the central nervous system: neuroprotection; anti-inflammatory properties similar to standard drugs for the treatment of inflammatory conditions; antioxidant properties, contributing to its therapeutic action.
Moringa oleifera is known for its nutritional and numerous medicinal uses that have been appreciated for centuries in many parts of habitat and introduced ranges. It belongs to Moringaceae family. In addition to its high nutritional value, this plant is very important for its medicinal value. Moringa oleifera has been reported to provide analgesic, antioxidant, anti-cancer, antimicrobial and anti-inflammatory effect.
The present work was designed to evaluate the effect of methotrexate (0. 6 mg/kg/week/by oral gavage), fluoxetine (20 mg/kg/day /by oral gavage) and Moringa oleifera seed extract (200 mg/kg/day /by oral gavage) on experimentally-induced rheumatoid arthritis in rats.
To study the effect of these drugs on induced adjuvant arthritis in rats, 30 male albino rats were classified into 5 equal groups (6 rats in each group). First group is normal control group. Second group is the diseased group, third group treated with methotrexate, fourth group treated with fluoxetine and fifth group treated with Moringa oleifera seed extract.
Adjuvant Arthritis was induced by S. C injection of 0. 4 ml of complete Freund's adjuvant in the right hind limb for 12 day in three doses (one dose every four days). The following parameters were measured RF, TNF-α, CRP, GSH, anti-CCP antibodies arthritis score and histopathological changes.
Subcutaneous injection of CFA produced increase in level of RF, TNF-α , CRP and anti-CCP antibodies compared to normal control group. Also, there was significant increase in arthritic score in diseased group at the end of 3 doses of CFA injection compared to before adjuvant injection. The diseased group showed progression of arthritis till the end of the experiment. While there was decrease in GSH level compared to normal control group. Regarding histopathological changes, there were proliferated blood vessels, prominent inflammatory infiltrate and villous formation.
Regarding, the treated groups leaded to significant improvement in serum RF, TNF-α, CRP, GSH, anti-CCP with improvement of arthritic score and the histopathology of the joint compared to normal control and diseased groups. Treatment with Moringa Oleifera seed extract showed the best results.
In addition, other treated groups rather than Moringa oleifera showed significant improvement in serum RF, TNF-α, CRP, GSH and anti-CCP compared to control and diseased groups.
Regarding arthritis score, a significant reduction in the score was seen in all treated group at the end of 3rd and 4th weeks. Moringa Oleifera group was the most effective group in improvement of the arthritic score at the end of 4th week of treatment (the end of the experiment).
Histopathology indicates improvement of the joint as regard synovial hyperplasia, villous formation, inflammatory cell infiltration and blood vessels proliferation. This improvement was observed in all treated groups with best result in Moringa Oleifera treated group.
From previous data one may assume that (conclusions):
Moringa Oleifera can be used as new treatment in cases of rheumatoid arthritis thus can decrease MTX dose to avoid its side effects.
Fluoxetine is a good antidepressant drug that has anti-inflammatory action. It is the best choice in depression that is common association with rheumatoid arthritis.
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