Arthritis – rechtzeitig handeln heißt behandeln

Abstract

Rheumatoid Arthritis (RA) is the most prevalent inflammatory joint disease in adults and shows a destructive course in most cases. The outcome of the disease - functional decline and invalidity - necessitates an early therapy. Recent studies demonstrate that the initiation of the treatment with a disease modifying antirheumatic drug (DMARD) treatment within the first three months after the onset of symptoms is crucial for sustained improvement of prognosis as well as therapeutic success and outcome. In the early stage of the disease, the criteria for the classification of Rheumatoid Arthritis (RA) are frequently not met. Up to over 50% of the patients show an arthritis, which cannot be classified and therefore is seen as undifferentiated arthritis (UA). Early therapeutic intervention appears to prevent the chronification of the disease; thus an early and appropriate disease modifying therapy is mandatory. Age, gender, involvement of the hands, positive rheumatoid factor, as well as the detection of anti cyclic-citrullinated peptide antibodies (anti-CCP Ab) are predictors of the development of RA. Beside conventional X-rays, there are other imaging methods such as magnetic resonance tomography imaging, Power-Doppler or contrast medium enhanced sonography, which may enable the detection not only of synovitis but also of erosive lesions at very early stages. Those patients suffering from UA carry a high risk for the development of a destructive arthritis as seen in RA, and therefore should be treated with an adequate DMARD. In these cases methotrexate is still the drug of first choice.

Disruptive Selection of Human Immunostimulatory and Immunosuppressive Genes Both Provokes and Prevents Rheumatoid Arthritis, Respectively, as a Self-Domestication Syndrome

“…Because it is best to study TBP-sites genome-wide, we created SNP_TATA_Comparator and applied it to build No. 147 dbSNP of 2016 to predict candidate SNP markers of RA (Chadaeva I. V. et al, 2019) as a cause of disability (Koller and Nobauer-Huhmann, 2009). The robustness of this tool was verified here with the growth of the SNP number, as seen in dbSNP build No.…”

“…Rheumatoid arthritis (RA) is an autoimmune disease involving autoantibodies (e.g., anti-citrullinated protein antibodies) and proinflammatory cytokines (e.g., TNF-α and IL-6) that participate in the induction of chronic synovitis and bone erosion, followed by deformity (Smolen and Aletaha, 2015), which are some of the most prevalent causes of disability (Koller and Nobauer-Huhmann, 2009). Currently, it is widely accepted that RA immunopathogenesis is mostly mediated by the mechanisms involving a breakdown of immune tolerance to self antigens that is characterized by an increase in the activity of effector T cells causing RA symptoms (Sarkander et al, 2016).…”

Synovial Immunohistological Biomarkers of the Classification of Undifferentiated Arthritis Evolving to Rheumatoid or Psoriatic Arthritis

“…UA represents 33-35% of patients in early arthritis clinics, usually as mono-or oligoarthritis. The UA course is variable (mild, chronic, or self-limited disease), and ∼20-50% of patients do not fulfill definite disease classification criteria after 1 year of follow up (6)(7)(8). In our early arthritis cohort (n = 381), we found that 30% of patients met criteria for RA, 10% for SpA and 16% did not fulfill criteria for any specific disease after 1 year of follow up (6).…”