Certo arthritis
Once in the synovium, initial activation of monocytes/macrophages may be induced by g-IFN secreted by activated CD4+ cells. certo arthritis Sternum pain. Chronic maintenance in the activated state, however, is presumably independent of g-IFN, but may be promoted by immune complexes (again containing a bacterial or viral antigen or rheumatoid factor itself). Support for this concept comes from synovial biopsies of RA synovium in which IgG, IgM and C3 can be demonstrated by immuno-fluorescence. GM-CSF, elaborated by the synovial fibroblast, may also feedback to sustain the macrophages in a mature, activated state, as already noted. certo arthritis Rhuematoid arthritis. Second, what factor(s) is responsible for the hypertrophy of the synovial lining? The predominant cells in the lining are macrophages and fibroblasts. Mature macrophages do not undergo mitosis, and few mitotic figures are observed in the fibroblast population either. A tantalizing, but as yet unproven theory, is that apoptosis of the fibroblast population is suppressed. certo arthritis Arthritis of the knee. This results in prolongation of the life of the fibroblast population, leading to increased numbers. (top of section)(top of page) Rational Approaches to the Treatment of Rheumatoid Arthritis Conventional agents Prevention Targeting the Initiation Stage Targeting the Propagation Stage Targeting Distal Events Future - Gene Therapy? Conventional agents have unknown mechanisms of action Use of these agents was prompted largely by empiric observations of their apparent efficacy, not by "rational drug design". These include methotrexate, gold, D-penicillamine, hydroxychloroquine, and other cytotoxic agents including azathioprine and cyclophosphamide (more info on pharmacologic strategies in RA treatments). Methotrexate is the most effective of this group of drugs and was the mainstay of treatment of RA until recent FDA approval of several new drugs (more info on new treatments)(also, see ACR Highlights). (top of section) Prevention Obviously, prevention is the most effective method of treatment but is not feasible until the cause of the disease is identified. If viral, vaccination would be a logical approach. (top of section) Targeting the initiation stage of disease Several therapeutic strategies are currently under investigation: Disrupt antigen presentation by DR4 This approach utilizes antibodies directed against the peptide-binding region and/or the shared motif of DR4 found in 90% of RA patients. The antibody would presumably block presentation of antigen to the host T cell by way of steric hindrance.
Certo arthritis
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