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Rheumatoid arthritis is a common disease, affecting around 1% of the population(1). ... However, knowledge of the central pathways and molecules involved in the inflammatory process has lead to the development of specific therapies to neutralise pro-inflammatory cytokines, for example the anti-TNF alpha drugs. These drugs have achieved promising results in clinical trials, however the health economics of these drugs have raised many issues.
The clinical features of Rheumatoid Arthritis can be divided into the regions affected. ... Finally, there are numerous extra-articular features of Rheumatoid Arthritis. ...
The trigger for the pathogenesis of rheumatoid arthritis remains elusive, but the explosion of knowledge of the pathogenesis itself in the past decade or so has lead to novel approaches to treating the disease. ... These cells stimulate monocytes, macrophages, and synovial fibroblasts to produce the cytokines IL1, IL6 and TNF-alpha, which have all been shown to be in moderate to high concentrations Rheumatoid Arthritis. (8) It is thought that TNF-alpha and Interleukin-1 act synergistically to stimulate cells such as fibroblasts and chondrocytes to produce metalloproteinases. These are a family of enzymes that remodel and destroy the extra-cellular matrix, and high concentrations of these enzymes, particularly in the combinations found in the synovial fluid of rheumatoid arthritis patients, are thought to participate in cartilage and bone degradation in the disease. TNF-alpha also stimulates osteoclasts, which are responsible for bone degradation. ...
The CD4+ cells also stimulate B cells, which produce immunoglobulins, including rheumatoid factor. Rheumatoid factor, along with other immune complexes, is released into the synovial fluid, where the immunocomplexes can be harmful in two ways. ... The second method is to block either the action or the production of the pro-inflammatory molecules, such as IL-1 and TNF-alpha. These approaches to treatment are an important step, as they allow early intervention with potent-anti-rheumatic drugs. ... Adopting this approach, the clinician would treat Rheumatoid Arthritis with low doses of simple analgesics at first. ... Whilst this approach has now been replaced with an intention to treat patients at an early stage with potent anti-rheumatics, the lack of potency and frequent side-effects of the previous DMARDs have been major problems.
Approximate Word count = 1805
Approximate Pages = 7.2
(250 words per page double spaced)
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