Rheumatoid arthritis: pathophysiology and implications for therapy

Article Abstract:

It has been estimated that approximately one out of every 100 people worldwide suffers from rheumatoid arthritis (RA). This chronic disease of the joints is currently being treated by various means, yet researchers have not demonstrated that the treatments are much good at altering the progression of the illness. On the contrary, evidence is mounting that the disability and death caused by RA has been underestimated. Diagnosis must be based on the symptoms and clinical course of the individual patient; there is no definitive test to identify the presence of the disease. While each case is slightly different, the following criteria are useful in diagnosing RA: morning joint stiffness lasting at least one hour; swelling of the tissue around the joints; positive results of a blood test for rheumatoid factor; a symmetrical pattern of arthritis; nodules under the skin; and abnormalities on X-rays of the hand and wrist. The choice of treatment should be based upon the stage, or degree of advancement, of RA. For stages one through four, the author discusses the pathobiology (disease process), diagnosis, clinical symptoms and appropriate therapy. Stage one often produces no symptoms, and therefore may not be diagnosed or treated. Diagnosis is often made in stage two or three, and therapy should begin promptly. Patients should be given extensive and ongoing instruction about the nature of RA, including its pattern of flares and remissions. They should be told how to maximize muscle strength and protect the joints, and how to manage the psychological stress that often accompanies this disease. Patients should balance sufficient rest with non-weight-bearing exercise to build muscle tone; this is an important and often neglected therapeutic approach. Dietary adjustments to replace animal fat with oils from fish and grains may be beneficial. Drug treatment typically focuses on the nonsteroidal anti-inflammatory drugs, and aspirin, which is tolerated well by some patients. Other drugs may be added if necessary to manage symptoms. In conclusion, treatment of RA should begin as early as possible in order to reduce or slow the progression of illness and disability. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Joint diseases, Arthritics

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Anticytokine therapy -- a new era in the treatment of rheumatoid arthritis?

Article Abstract:

Drugs that block the action of tumor necrosis factor (TNF) may be beneficial in the treatment of rheumatoid arthritis. TNF is a natually occurring immune system chemical that is involved in inflammation. However, excess levels can damage the joints. Infliximab and etanercept are two drugs that block TNF. Studies have shown that both drugs are more effective when used in addition to methotrexate than methotrexate alone. Because infliximab is created using mouse antibodies, humans may have an adverse reaction to it. Etanercept contains only human proteins and may therefore be safer.

Monoclonal antibodies

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Biologic therapy for rheumatoid arthritis

Article Abstract:

It is mow possible to treat rheumatoid arthritis patients with two drugs that slow the progression of the disease. Etanercept and infliximab both inhibit tumor necrosis factor, which is a pro-inflammatory substance that occurs naturally in the body.

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