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So What Is The Best Approach To Treating Rheumatoid Arthritis...
What Do I Need To Know If I, Or A Close Relative Has The Disease?
By Nathan Wei
Rheumatoid arthritis is a
chronic, progressive, systemic, inflammatory, autoimmune disease for which there
is no current cure. However, there are important and effective advances which
have made it possible to put this disease into remission.
The most important advances in treatment in the last 25 years have been the
use of methotrexate as a disease modifying anti-rheumatic drug (DMARD) and the
use of biologic therapies to get this disease into remission.
Before discussing therapy, it is critical that a rapid, accurate diagnosis
of RA be made as soon as possible. This is because the damage to both joints as
well as internal organs may occur early in the course of illness.
Newer laboratory tests such as the anti-CCP as well as imaging techniques
such as magnetic resonance imaging and diagnostic ultrasound have made the
diagnosis easier.
A recent study has demonstrated that patients with shorter duration of
disease and less severe disability are increasingly being treated with biologic
therapies. (Soderlin MK, et al. (Ann Rheumatic Dis. 2008; 67:37-42).
Why is this approach a good one?
Another recent study has demonstrated that TNF-inhibitors, the first line
biologic therapies used disrupt the architecture of structures in the lymph
system called germinal centers, which are a type of training ground for immune
cells.
Normally, the structures help when the host is ill from an infection. The
structures swiftly churn out lots of B cells, which the body uses to destroy
invaders.
In healthy people, once an infection is beaten off, the germinal centers
fade away. But in people with a chronic autoimmune disease like rheumatoid
arthritis, these germinal centers continue to train immune cells to become
autoimmune attackers.
A team of researchers from the University of Rochester found that anti-TNF
compounds inhibit the function and organization of cells known as follicular
dendritic cells, which help form the germinal centers.
Follicular dendritic cells have long tentacles that lock onto B cells and
hold them in place during their training.
The researchers found that the anti-TNF medication dropped the percentage of
B cells in the lymph tissue by about 40 percent in patients. They also found
that arthritis patients who received anti-TNF therapy had about one-quarter the
number of germinal centers as other arthritis patients. The germinal centers
that did exist in patients were smaller and less organized.
TNF, a chemical messenger that stimulates the immune system, is an important
trigger for diseases like rheumatoid arthritis. In fact, TNF inhibitors such as
Enbrel, Humira, and Remicade have been extremely effective in inducing remission
in most patients with RA.
More recently, a drug known as rituximab that targets B cells was approved
in 2006 to treat rheumatoid arthritis. The effectiveness of that drug against
rheumatoid arthritis supports the findings of the Rochester team and shows how
both TNF inhibitors as well as B-cell therapies may have complementary roles in
treating RA.
The upshot of the recent research is that:
- RA needs to be diagnosed early
- It needs to be treated aggressively by a well-trained rheumatologist
- No one drug will be effective for every patient and that different
approaches may be required. That is why an expert needs to be consulted.
About the Author: Nathan Wei, MD FACP FACR is a rheumatologist and Director
of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant
Professor of Medicine at the University of Maryland School of Medicine. For more
info:
Arthritis Treatment
Source: www.isnare.com
Permanent Link:
http://www.isnare.com/?aid=222938&ca=Medicines+and+Remedies
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