Recent advances in rheumatoid arthritis

Abstract

Management of rheumatoid arthritis (RA) has radically changed over the last decade. Diagnostic methods have improved with availability of highly specific tests such as antibody to cyclic citrullinated peptide (specificity approximately 96%), and introduction of advanced imaging modalities such as ultrasound and magnetic resonance imaging to facilitate earlier diagnosis. The current aim of management is to achieve remission and prevent joint damage. In order to achieve this goal, inflammation is suppressed as much as possible during the early phase of the disease before onset of joint damage. Aggressive treatments with combinations of disease modifying anti-rheumatic drugs are commenced earlier in the course of disease, and tight control maintained with regular objective monitoring of disease activity. Early use of anti-TNFalpha (tumour necrosis factor alpha) therapy in combination with methotrexate helps to achieve better clinical and radiographic outcomes, which can be maintained for up to 5 years after withdrawal of anti-TNFalpha therapy. Apart from anti-TNFalpha, several other biological treatments are now available, including those that target CD20 on B cells (rituximab), cytokines such as IL1 (anakinra) and IL6 (tocilizumab), and molecules that cause interaction between antigen presenting cells and T cells (abatacept). There is better awareness and understanding of RA associated complications such as cardiovascular disease and osteoporosis. Use of non-steroidal anti-inflammatory drugs is on the decline in light of recent concerns about cardiovascular safety. Evidence is emerging in support of statins and bisphosphonates for improving RA disease activity and preventing erosions, respectively. In the coming years, further improvements in therapeutic strategies are likely with the pace at which research is currently progressing.

Artrite reumatoide: uma visão atual

“…Prevenir dano articular e conseguir remissão têm se tornado alvos possíveis de serem alcançados. Embora agentes biológicos como os anti-TNF-α tenham demonstrado atuar de maneira positiva na diminuição da aterosclerose, ainda não se demonstrou redução da taxa de mortalidade em AR nos últimos 50 anos (63).…”

Measures in rheumatoid arthritis: are we measuring too many parameters

“…Both TJC and SJC, although representing the clinical features of inflammation, can significantly be influenced by the use of non‐steroidal anti‐inflammatory drugs (NSAIDs), patient's anxiety and depression, and have significant inter‐observer variability . Studies have indicated that the number of erosions and deformities are proportional to the persistence of inflammation, as well as its duration . Drawing a corollary from diabetes mellitus (DM) where the basic target is good control of plasma/blood sugar, the aim and scope of measurement of RA is inflammation.…”

Stereoselective Total Synthesis of (+)-Aristolactam GI

“…oldhamii have been used as a folk medicine to treat rheumatoid arthritis (RA) in southern China . It is thought that tumor necrosis factor α (TNFα), interleukin-1 (IL-1), and interleukin-2 (IL-2) play important roles in the pathophysiology of RA, and therapies targeting these proteins have shown positive outcomes in treatment of RA . Ge et al examined the inhibitory effects of aristolactam GI ( 1 ) upon the release of TNFα and IL-6 induced by lipopolysaccharide in murine macrophage RAW264 cell cultures, and it was shown that aristolactam GI ( 1 ) exhibited statistically significant inhibition in the production of both TNFα and IL-6.…”