Rheumatoid Arthritis: Etiology and Pathogenesis

2014 ◽  
Author(s):  
Gary S. Firestein ◽  
Anna-Karin H. Ekwall
Keyword(s):  
Rheumatoid Arthritis ◽  
Intracellular Signaling ◽  
Cartilage Damage ◽  
Signs And Symptoms ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Citrullinated Proteins ◽  
Definition Of

Rheumatoid arthritis (RA) is among the most common forms of chronic inflammatory arthritis. It affects approximately 1% of adults and is two to three times more prevalent in women than in men. There are no specific laboratory tests for RA; diagnosis depends on a constellation of signs and symptoms that can be supported by serology and radiographs. The disease evolves over many years as a consequence of repeated environmental stress causing inflammation and immune activation followed by a breakdown of tolerance in individuals with a specific genetic background. This review describes the definition of RA; its etiology, including genetics, infections, the role of smoking and citrullination of proteins, and epigenetic mechanisms; and its pathogenesis, including synovial histopathology, bone and cartilage damage, adaptive and innate immunity, and the role of cytokines and intracellular signaling. Tables include the 1987 American Rheumatism Association criteria for the classification of RA and the 2010 American College of Rheumatology/European League Against Rheumatism classification for RA. Figures show citrullinated proteins in airway cells, a section of a proliferative synovium from a patient with a classic RA, and scalloped regions of erosion at the junction between a proliferative inflamed rheumatoid synovium and the bone. This review contains 3 highly rendered figures, 2 tables, and 71 references.

scholarly journals The role of imaging in rheumatoid arthritis

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Kgomotso Kgoebane ◽  
Mahmood M.T.M. Ally ◽  
Martha C. Duim-Beytell ◽  
Farhana E. Suleman
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Process ◽  
Classification Criteria ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Soft Tissue Involvement ◽  
Imaging Detection ◽  
Hands And Feet

Conventional radiographs of the hands and feet have traditionally been used in the diagnosis, management and monitoring of patients with rheumatoid arthritis (RA). However, they are not sensitive enough to detect changes early in the disease process. Erosions may only be visible up to two years after the onset of disease, and soft tissue involvement may not be detected at all. Early diagnosis can also be made challenging as markers such as erythrocyte sedimentation rate and C-reactive protein may be normal in up to 20% – 25% of cases. The latest classification criteria (American College of Rheumatology/European League Against Rheumatism [ACR/EULAR] Rheumatoid Arthritis Classification criteria 2010), often used to diagnose RA, incorporate the role of ultrasound and magnetic resonance imaging detection of synovitis, enabling earlier diagnosis and correct classification of patients. This article looks at the role of the various imaging modalities used in the diagnosis and management of RA.

scholarly journals The Role of Posttranslational Protein Modifications in Rheumatological Diseases: Focus on Rheumatoid Arthritis

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Andrea Mastrangelo ◽  
Tania Colasanti ◽  
Cristiana Barbati ◽  
Arbi Pecani ◽  
Danilo Sabatinelli ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Antigen Processing ◽  
Systemic Autoimmune Disease ◽  
Protein Functions ◽  
Citrullinated Proteins ◽  
Wide Group ◽  
Definition Of ◽  
Antigen Processing And Presentation ◽  
Rheumatological Diseases

The definition of posttranslational modification (PTM) encompasses a wide group of chemical reactions that allow modification and modulation of protein functions. The regulation of PTMs is crucial for the activity and survival of the cells. Dysregulation of PTMs has been observed in several pathological conditions, including rheumatoid arthritis (RA). RA is a systemic autoimmune disease primarily targeting the joints. The three PTMs mainly involved in this disease are glycosylation, citrullination, and carbamylation. Glycosylation is essential for antigen processing and presentation and can modulate immunoglobulin activity. Citrullination of self-antigens is strongly associated with RA, as demonstrated by the presence of antibodies directed to anti-citrullinated proteins in patients’ sera. Carbamylation and its dysregulation have been recently associated with RA. Aim of this review is to illustrate the most significant alterations of these PTMs in RA and to evaluate their possible involvement in the pathogenesis of the disease.

scholarly journals American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials

2011 ◽  
Vol 63 (3) ◽  
pp. 573-586 ◽  
Author(s):  
David T. Felson ◽  
Josef S. Smolen ◽  
George Wells ◽  
Bin Zhang ◽  
Lilian H. D. van Tuyl ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Definition Of ◽  
European League

Diagnostic Accuracy of ACR/EULAR 2010 Criteria for Rheumatoid Arthritis in a 2-Year Cohort

2011 ◽  
Vol 38 (7) ◽  
pp. 1250-1257 ◽  
Author(s):  
SOPHIE VARACHE ◽  
DIVI CORNEC ◽  
JOHANNE MORVAN ◽  
VALÉRIE DEVAUCHELLE-PENSEC ◽  
JEAN-MARIE BERTHELOT ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Exclusion Criteria ◽  
Recent Onset ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Sensitivity Specificity ◽  
Tree Condition

Objective.To evaluate the diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and 1987 ACR criteria for rheumatoid arthritis (RA), and the respective role of the algorithm and scoring of the ACR/EULAR.Methods.In total, 270 patients with recent-onset arthritis of < 1 year duration were included prospectively between 1995 and 1997 and followed for 2 years. RA was defined as the combination, at completion of followup, of RA diagnosed by an office-based rheumatologist and treatment with a disease-modifying antirheumatic drug or glucocorticoid. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the criteria sets in the overall population, in the subgroup meeting the tree condition for ACR/EULAR scoring, and in the overall population classified according the full tree.Results.At baseline, 111 of the 270 patients had better alternative diagnoses and 16 had erosions typical for RA; of the 143 remaining patients, 52 had more than 6 ACR/EULAR 2010 points (indicating definite RA) and 91 had fewer than 6 points. After 2 years, 11/16 patients with erosions and 40/52 with more than 6 points had RA. 100 of the 270 patients met the reference standard for RA. Sensitivity, specificity, PPV, and NPV of the ACR/EULAR (full tree) were 51/100 (51%), 153/170 (90%), 51/68 (75.4%), and 153/202 (75.7%), respectively. Diagnostic accuracies of the ACR/EULAR score and ACR 1987 criteria were not statistically different.Conclusion.Much of the improvement of the ACR/EULAR criteria was ascribable to the use of exclusion criteria in the algorithm.

Limitations in the Classification of Childhood-onset Rheumatoid Arthritis

2014 ◽  
Vol 41 (3) ◽  
pp. 547-553 ◽  
Author(s):  
Emily G. Ferrell ◽  
Lori A. Ponder ◽  
Lauren S. Minor ◽  
Sheila T. Angeles-Han ◽  
Christine W. Kennedy ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Childhood Onset ◽  
Chi Square ◽  
Exact Test ◽  
Number Of Children ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Peptide Antibody ◽  
Student’S T

Objective.Rheumatoid factor-positive polyarthritis (RF+ poly) is the juvenile idiopathic arthritis (JIA) category that resembles adult seropositive rheumatoid arthritis (RA). We studied children with RF+ and/or anticyclic citrullinated peptide antibody (anti-CCP)+ JIA to determine what proportion of those children meet International League of Associations for Rheumatology (ILAR) criteria for RF+ poly JIA and to assess for significant differences between children who meet RF+ poly criteria and those who are classified in other categories.Methods.Charts of children with JIA who were RF+ and/or anti-CCP+ were reviewed. Children with RF+ poly JIA were compared to children in other categories. Statistical analysis was performed using chi-square, Fisher’s exact test, and the Student’s t-test.Results.Of 56 children with RF+ and/or anti-CCP+ JIA, 34 (61%) met ILAR criteria for RF+ poly JIA. Twelve children had RF–/anti-CCP+ JIA with low anti-CCP titers. When these 12 children were excluded, there were few significant differences between children who met criteria for RF+ poly and those who were classified in other categories. The American College of Rheumatology/European League Against Rheumatism criteria for RA identified more RF+ children than did the ILAR RF+ poly classification (100% vs 77%).Conclusion.A number of children with RF+ arthritis were excluded from the RF+ poly JIA classification, though many demographic features and disease measures were similar to those of children who met criteria for RF+ poly JIA. We propose prioritization of RF/anti-CCP positivity over specific exclusions, along with inclusion of anti-CCP, in future revisions of the JIA classification criteria, to improve the sensitivity of diagnosing childhood-onset RA.

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