Autoimmune Mechanisms Involved in the Pathogenesis of Rheumatoid Arthritis

1996 ◽  
Vol 10 (1) ◽  
pp. 47-51 ◽  
Author(s):  
R.C. Williams
Keyword(s):  
Rheumatoid Arthritis ◽  
Progressive Disease ◽  
Plasma Cells ◽  
Disease Process ◽  
Underlying Disease ◽  
Autoantibody Production ◽  
Rheumatoid Nodules ◽  
Immune Mediated ◽  
Lymphocytic Infiltrates ◽  
Insight Into

Rheumatoid arthritis (RA) was one of the first systemic disorders to be considered an autoimmune disease. Two major aspects of RA suggest a fundamental immune-mediated derangement in the disease: (1) presence of often massive lymphocytic infiltrates and activated CD4(+) T cells within the inflamed hypertrophied synovium, and (2) production of large amounts of rheumatoid factor (RF) by B-cells and plasma cells in the involved synovium itself. The actual tissue damage to joints and extra-articular structures affected by the disease comes from the rheumatoid inflammatory pannus or granulomatous collections of cells called rheumatoid nodules. RF production has long been studied as a prime example of apparent autoantibody production in association with the basic underlying disease process. RA patients who belong to subtype HLA DR4, Dw4 (DR B1 or 0401, Dw14 (0404/0408), or Dw15 (0405/0410) are most likely to be seropositive for RF and to have severe progressive disease. RFs are felt to represent an autoantibody associated with RA, since they show principal specificity for structures on the Cγ3 and C γ2 (Fc) domains of IgG. Recent work by our group has defined a number of solvent-exposed linear RF-reactive epitopes on Cγ3 and Cγ2 using a strategy of overlapping 7-mers of primary sequence. RFs also have been demonstrated to react with two different regions, SKDWSFY and LSQPKIVKWDR, on β2-microglobulin (β 2m). Many of the RF-reactive sites on Cγ2 and C γ3 as well as on β2m show common immunodominant valines, leucines, tryptophanes, arginines, lysines, and glutamines, thus comprising common reactive residues. In the future, this approach may provide more direct insight into the specificities of other autoantibodies.

Tocilizumab: An Updated Review of Its Use in the Treatment of Rheumatoid Arthritis and Its Application for Other Immune-Mediated Diseases

2013 ◽  
Vol 5 ◽  
pp. CMT.S9282 ◽  
Author(s):  
Toshio Tanaka ◽  
Atsushi Ogata ◽  
Masashi Narazaki
Keyword(s):  
Rheumatoid Arthritis ◽  
Immune Responses ◽  
T Cell Subsets ◽  
Unknown Etiology ◽  
Autoantibody Production ◽  
Future Studies ◽  
Effector T Cell ◽  
Immune Mediated ◽  
Cell Source ◽  
Acute Phase Reactions

Interleukin-6 (IL-6), produced by a variety of cells, is a typical cytokine featuring redundancy and pleiotropic activity. IL-6 is promptly and transiently synthesized in response to infections or injuries, and participates in host defense by inducing immune responses, hematopoiesis, and acute-phase reactions. However, since its abnormal persistent production of mostly unknown etiology plays an important pathological role in the development of various immune-mediated diseases, a humanized anti-IL-6 receptor monoclonal antibody, tocilizumab, was developed and is now used as an innovative biologic for rheumatoid arthritis in more than 90 countries. Several factors strongly suggest that a IL-6 blockade strategy may have a broad application for the treatment of various immune-mediated diseases. These factors include favorable results of pilot or case studies with off-label use of tocilizumab, pathological analyses of the contribution of IL-6 to the development of immune-mediated diseases, and the potential capability of tocilizumab to both repair an imbalance of effector T cell subsets and to suppress pathologic autoantibody production. However, clinical trials to evaluate the efficacy and safety of tocilizumab for these diseases are essential. Furthermore, clarification of the cell source of IL-6 production and of the mechanisms through which dysregulated continuous IL-6 synthesis is induced constitutes an important issue for future studies into the pathogenesis of diseases.

Conservative Management of the Hypersensitive Foot in Rheumatoid Arthritis

Foot & Ankle ◽  
1982 ◽  
Vol 2 (4) ◽  
pp. 224-229 ◽  
Author(s):  
John S. Gould
Keyword(s):  
Rheumatoid Arthritis ◽  
Conservative Management ◽  
Subtalar Joint ◽  
Progressive Disease ◽  
Disease Process ◽  
Nonsurgical Treatment ◽  
Irregular Shapes ◽  
Longitudinal Arch ◽  
Clinical Problems

Treatment of the painful foot in rheumatoid arthritis requires an understanding of the abnormal mechanics and progressive disease process. The clinical problems are manifested in the forefoot (MP joints and toes) and in the longitudinal arch and subtalar joint. The evaluation includes a thorough history and physical, and the use of various tools to indicate and quantitate abnormal weightbearing, problems in circulation and sensation. Nonsurgical treatment includes appropriate drugs, and devices and shoes which reduce shear, redistribute weightbearing, support unstable joints, and accommodate irregular shapes and surfaces. Certain infections and neurovascular problems require early surgical solutions.

scholarly journals Local and generalized bone loss in rheumatoid arthritis

2021 ◽  
Vol 15 (5) ◽  
pp. 103-107
Author(s):  
P. S. Kovalenko ◽  
N. I. Kolganova ◽  
I. S. Dydykina ◽  
P. O. Kozhevnikova ◽  
M. Yu. Blank
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Loss ◽  
Treatment Strategies ◽  
Underlying Disease ◽  
Mineral Density ◽  
Biologic Dmards ◽  
Cross Sectional ◽  
Local Bone ◽  
Immune Mediated ◽  
Antiresorptive Drugs

The article presents a review of cross-sectional studies and long-term prospective observations dedicated to changes in bone mineral density (BMD) in patients with rheumatoid arthritis (RA) and factors influencing it. The relationship between local bone loss (erosion count) and generalized BMD loss was noted. It is indicated that existing RA treatment strategies are aimed at suppressing inflammation rather than preventing bone resorption. There is evidence that anti-inflammatory therapy using glucocorticoids, methotrexate, and biologic DMARDs in combination with antiresorptive drugs (bisphosphonates and denosumab) helps prevent BMD loss and the progression of erosions. It is emphasized that osteoporosis in RA, which belongs to the immune-mediated secondary osteopathies, is one of the most frequent and serious complications of RA, which determine the unfavorable course and prognosis of the underlying disease.

Clinical Signs, Clinicopathological Findings, Etiology, and Outcome Associated With Hemoptysis in Dogs: 36 Cases (1990–1999)

2002 ◽  
Vol 38 (2) ◽  
pp. 125-133 ◽  
Author(s):  
Nathan L. Bailiff ◽  
Carol R. Norris
Keyword(s):  
Heart Failure ◽  
Clinical Signs ◽  
Disease Process ◽  
Underlying Disease ◽  
Initial Visit ◽  
Lung Lobe ◽  
Immune Mediated ◽  
Clinicopathological Findings ◽  
Heartworm Disease ◽  
Underlying Diseases

Hemoptysis, the expectoration of blood or bloody mucus from the respiratory tract at or below the larynx, was retrospectively evaluated in 36 dogs. Cough, tachypnea, and dyspnea were common historical and physical examination signs. Anemia was documented in 11 dogs, but was severe in only one dog. Other clinicopathological findings reflected the underlying diseases. All thoracic radiographs obtained were abnormal; alveolar and interstitial patterns were most common. Diseases predisposing to hemoptysis included bacterial bronchopneumonia (n=7), neoplasia (n=5), trauma (n=5), immune-mediated thrombocytopenia (n=4), heartworm disease (n=4), rodenticide poisoning (n=3), lung-lobe torsion (n=1), left-sided congestive heart failure (n=1), pulmonary hypertension (n=1), and foreign-body pneumonia (n=1). Four additional dogs had more than one underlying disease process. Nine dogs were either euthanized or died in the hospital during the initial visit. While at least half of the 27 dogs discharged went on to completely recover, five dogs discharged were known to have either died or been euthanized as a result of their disease in <6 months.

Slow-acting antirheumatic drugs

1993 ◽  
Vol 31 (5) ◽  
pp. 17-20
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Process ◽  
Underlying Disease ◽  
Disease Outcome ◽  
Serological Markers ◽  
Antirheumatic Drugs ◽  
Slow Progression ◽  
The Uk ◽  
Underlying Disease Process

Rheumatoid arthritis (RA) is common and debilitating. It affects approximately 1% of adults in the UK, with a prevalence which increases with age; over the age of 60 years roughly 2% of men and 5% of women are affected.1 Early in the disease most patients will receive analgesics and NSAIDs, which relieve symptoms but do not affect the underlying disease process.2 Slow-acting antirheumatic drugs (SAARDs) – gold, penicillamine, hydroxychloroquine/chloroquine or sulphasalazine – have conventionally been used later.3 These drugs act slowly, improve symptoms and suppress clinical and serological markers of RA activity. Moreover they appear to slow progression of the disease, although whether they modify disease outcome in the long term is not clear. Many rheumatologists now advocate their earlier use in some patients. We review the place of SAARDs, including methotrexate and immunosuppressants, in the treatment of RA.

Drug-Induced Movement Disorders

2015 ◽  
Vol 25 (2) ◽  
pp. 70-77
Author(s):  
Amy Lustig ◽  
Cesar Ruiz
Keyword(s):  
Movement Disorders ◽  
Medical Management ◽  
Disease Process ◽  
Underlying Disease ◽  
Extrapyramidal Symptoms ◽  
Drug Induced ◽  
General Overview ◽  
Management Approaches ◽  
Broad Understanding ◽  
Underlying Disease Process

The purpose of this article is to present a general overview of the features of drug-induced movement disorders (DIMDs) comprised by Parkinsonism and extrapyramidal symptoms. Speech-language pathologists (SLPs) who work with patients presenting with these issues must have a broad understanding of the underlying disease process. This article will provide a brief introduction to the neuropathophysiology of DIMDs, a discussion of the associated symptomatology, the pharmacology implicated in causing DIMDs, and the medical management approaches currently in use.

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

2018 ◽  
Vol 68 (12) ◽  
pp. 2987-2991
Author(s):  
Cristina Iordache ◽  
Bogdan Vascu ◽  
Eugen Ancuta ◽  
Rodica Chirieac ◽  
Cristina Pomirleanu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Temporomandibular Joint ◽  
Final Analysis ◽  
Cross Sectional Study ◽  
Joint Disease ◽  
Sectional Study ◽  
Cross Sectional ◽  
Immune Parameters ◽  
Immune Mediated

Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders accounting for significant disability and impaired quality of life. The aim of our study was to assess inflammatory and immune parameters in patients with TMJ arthritis related to rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify potential relation with severity and dysfunction of TMJ pathology. We performed a cross-sectional study in a cohort of 433 consecutive RA, 32 JIA, 258 AS, and 103 PsA. Only patients presenting with clinically significant TMJ involvement (273) related to their rheumatic condition were included in the final analysis. TMJ involvement is traditionally described in chronic inflammatory rheumatic disorders, particularly in patients with higher levels of inflammation as detected in rheumatoid arthritis and psoriatic arthritis. Disease activity and severity, as well as biological and positive serological assessments (rheumatoid factor, anti-cyclic citrullinated peptide, IL-1) remain significant determinants of the severity of TMJ arthritis.

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