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Comparison of individual and combination treatments with naproxen, prednisolone and hydroxychloroquine to treat Complete Freund’s Adjuvant induced arthritis

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Abstract

Aim of this study was to evaluate and compare the efficacy of anti-arthritic drugs (naproxen, prednisolone, and hydroxychloroquine) alone and in combination. The in vitro anti-arthritic activity was evaluated by stabilization of human erythrocytes (HRBCs) membrane assays. In vivo activity was carried out using Complete Freund’s Adjuvant (CFA) induced arthritic model in Wistar rat. Individual and combination drugs were administered for 21 days in rats 8 days post inoculation with CFA (0.15 ml injected in right hind paw). Body weight and paw edema were measured at different intervals. Combination treatments exhibited more HRBC stabilization than individual treatments. All individual and combination treatments reduced the level of C-reactive protein (CRP), liver function enzymes, malondialdehyde, white blood cells and platelets, with the most pronounced activity exhibited by the combination of three drugs. The level of oxidative stress biomarkers (reduced glutathione, catalase, and superoxide dismutase), red blood cells, and hemoglobin were notably increased in all treatment groups in contrasts to diseased control rats. Histopathological evaluation of the paw showed that all the treatments had reduced (p < 0.05–0.001) the arthritic indices in contrasts to diseased control rats. The serum concentrations of TNF-α and PGE2 were provoked in diseased control rats but had been notably (p < 0.0001) restored by treatments with individual and combination drugs. It was also found that combination treatments, more precisely triple drug was remarkably effective in treating arthritis. It can be concluded that naproxen, prednisolone, and hydroxychloroquine effectively ameliorated the CFA-induced arthritis and were more effective in combination as compared to individual drug therapy probably due to reduction in oxidative stress and inflammatory markers. Moreover, two lower doses (half NPH/2 and one-third NPH/3) of triple combination therapy naproxen, prednisolone, and hydroxychloroquine (NPH) showed no significant difference in anti-arthritic effect as compared to the highest dose level of NPH.

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Acknowledgements

This work was supported by the Taif University Researchers Supporting Program (Project number: TURSP-2020/153), Taif University, Saudi Arabia. Authors are also thankful to Riphah International University, Pakistan for the provision of necessary laboratory and animal care facilities.

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Authors and Affiliations

  1. Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore Campus, Lahore, Pakistan

    Muhammad Furqan Akhtar & Summiya Zubair

  2. Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan

    Ammara Saleem

  3. Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia

    Khalaf F. Alsharif

  4. Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, P.O. Box 6231, Jeddah, 21442, Saudi Arabia

    Mohamed M. Abdel-Daim

  5. Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt

    Mohamed M. Abdel-Daim

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  1. Muhammad Furqan Akhtar
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Correspondence to Muhammad Furqan Akhtar or Ammara Saleem.

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Akhtar, M.F., Zubair, S., Saleem, A. et al. Comparison of individual and combination treatments with naproxen, prednisolone and hydroxychloroquine to treat Complete Freund’s Adjuvant induced arthritis. Inflammopharmacol 29, 1719–1731 (2021). https://doi.org/10.1007/s10787-021-00875-y

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