Plant extracts have been used for the treatment of fever and aches

Plant Extracts have been used for the treatment of fever and aches since ancient Egyptian and Roman times. The era of antiinflammatory drugs, however, began with the extraction of aspirin from willow bark in the early 19th century.19,20 The second wave of innovation for the treatment of inflammatory diseases came in the mid-20th century with the discovery of phenylbutazone, indomethacin, and ibuprofen-a group of drugs commonly referred to as NSAIDs.19,20 Although aspirin and NSAIDs successfully alleviated pain and fever, they were ineffective in preventing disease progression. Glucocorticoids, introduced in the 1950s, had disease-modifying characteristics and revolutionized the treatment of numerous chronic inflammatory conditions. However, long-term glucocorticoid therapy at high doses, often required to treat these chronic disabling conditions, can lead to major metabolic and nonmetabolic adverse effects.19–21 Consequently, an extensive search for safer antiinflammatory and disease-modifying drugs ensued, and a range of biological and nonbiological DMARDs were introduced.19–21 Biological DMARDs, often referred to as [biologics," are a homogenous group of recombinant monoclonal peptides or fusion proteins. However, a large group of nonbiological DMARDs are diverse in structure and characteristics, and include drugs such as sulfasalazine, cyclosporine, levamisole, and methotrexate, among others.

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Normal inflammatory response is mediated by an array of cytokines, which are peptides released by a variety of cells in order to augment the function of other similar cells.20,21 The various cytokines typically act synergistically at extremely low concentrations; therefore blockade of one can interrupt the entire inflammatory cascade.20,21 Biological DMARDs are antibodies to several cytokines, specifically TNF-α, interleukin-1 (IL-1), and IL-6, and their antiinflammatory properties are due to the targeted inhibition of these key cytokines.20,21 Given that their targets are primarily extracellular, biological DMARDs have few metabolic consequences, and their primary side effect is increased susceptibility to infections. In comparison, nonbiological DMARDs have diverse mechanisms of action. They are frequently potent antimetabolites and suppress cellular replication and inflammatory response. Consequently, nonbiological DMARDs often cause serious immunosuppressive and metabolic adverse effects in a dose-dependent manner. DMARDs are being used increasingly for the treatment of a host of chronic inflammatory and autoimmune conditions such as rheumatoid arthritis, Crohn disease, inflammatory bowel disease, psoriasis, and ankylosing spondylitis. DMARD use in these conditions is characterized by a protocol-driven approach, and a typical DMARD regimen often consists of a combination of one or two biological drugs along with a nonbiological DMARD.22

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2021.11.15