Effectivenes of Spironolacton in Complex Therapy of Rheumatoid Arthritis

Abstract

Aldosterone blocker – Spironolactone has anti-inflammatory, anti-proliferative and anti-oxidative effects, that is why pathogenetically it is expedient to use it in complex therapy of rheumatoid arthritis.Material and methods: 46 patients with RA took 25-50 mg/day of Spironolactone during 12 months as an addition to standard therapy, the comparison group consisted of 47 patients that got only standard therapy, all the patients were fully examined prior and post the treatment.Results: complex RA therapy leads to improved VAS, HAQ, the antioxidative potential index F; decreased blood concentrations of TNF-α, ICAM-1, FGF and VEGF in contrast to standard therapy. Complex therapy made reduced the DAS 28 more > 0.6.Conclusions: applying of Spironolactone in complex therapy of rheumatoid arthritis contributes to more pronounced improvement in indices of articular syndrome and patient’s life quality, reduce of anti-inflammatory, anti-proliferative and angiogenic cytokines, and more effectively reduces the activity of the disease comparing to standard therapy.

Spironolactone (an adjuvant therapy) in rheumatoid arthritis: a case control study

“…Komarova and Rebrov [ 11 ] followed patients with RA for 12 months while they were on additional therapy of 25–50 mg/day of spironolactone and observed a significant reduction in DAS28 value ( p -value = 0.048) and also found improvement in the VAS and HAQ (Health Assessment Questionnaire), suggesting improvement in patients’ quality of life. It concluded that spironolactone contributes to more pronounced improvement in indices along with reduction of anti-inflammatory, anti-proliferative and angiogenic cytokines and more effectively reduces disease activity.…”

“…Spironolactone is a steroid that blocks mainly the effects of the hormone aldosterone but also its antiinflammatory anti-proliferative and anti-oxidant effects are described. However, few studies have shown the effectiveness of spironolactone in therapy of rheumatoid arthritis [ 11 , 13 ]. This is because it blocks aldosterone, which possesses proinflammatory and profibrotic properties, due to its stimulating action on cytokines, molecules of adhesion and different growth factors [ 14 , 15 ].…”

“…Increase of aldosterone levels in synovial fluid leads to persistent hypoxia, which may induce genotoxic agents, leads to DNA disturbance and synovial cell mutation, exaggerates fibroblast proliferation and reduces the opportunity of cell apoptosis, which contributes to pannus mass progressive growth and cartilage erosion in RA [ 15 ]. Only limited studies are available regarding the role of spironolactone as adjunctive therapy with DMARDs in RA [ 11 – 13 ].…”