Rheumatoid arthritis is a chronic, progressive, systemic, inflammatory, autoimmune disease for which there is no current cure. However, there are important and effective advances which have made it possible to put this disease into remission.
The most important advances in treatment in the last 25 years have been the use of methotrexate as a disease modifying anti-rheumatic drug (DMARD) and the use of biologic therapies to get this disease into remission.
Before discussing therapy, it is critical that a rapid, accurate diagnosis of RA be made as soon as possible. This is because the damage to both joints as well as internal organs may occur early in the course of illness.
Newer laboratory tests such as the anti-CCP as well as imaging techniques such as magnetic resonance imaging and diagnostic ultrasound have made the diagnosis easier.
A recent study has demonstrated that patients with shorter duration of disease and less severe disability are increasingly being treated with biologic therapies. (Soderlin MK, et al. (Ann Rheumatic Dis. 2008; 67:37-42).
Why is this approach a good one?
Another recent study has demonstrated that TNF-inhibitors, the first line biologic therapies used disrupt the architecture of structures in the lymph system called germinal centers, which are a type of training ground for immune cells.
Normally, the structures help when the host is ill from an infection. The structures swiftly churn out lots of B cells, which the body uses to destroy invaders.
In healthy people, once an infection is beaten off, the germinal centers fade away. But in people with a chronic autoimmune disease like rheumatoid arthritis, these germinal centers continue to train immune cells to become autoimmune attackers.
A team of researchers from the University of Rochester found that anti-TNF compounds inhibit the function and organization of cells known as follicular dendritic cells, which help form the germinal centers.
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