Rheumatoid arthritis and the concept of autoimmune disease
Journal Title: International Journal of Clinical Rheumatology - Year 2019, Vol 14, Issue 2
Abstract
We critically review the concept of autoimmunity in Rheumatoid Arthritis (RA). To classify a disease as autoimmune, it is necessary to demonstrate that the immune response to a self-antigen causes the observed pathology. In RA, neither autoantigens nor autoreactive T-cell clones were found. Molecular mimicry exists in some cases, e.g. after Proteus mirabilis infection. In some patients, cross-reactivity between microbial DnaJ and human HSP40 can occur. However, none of the autoantibodies described in RA, with perhaps exception of Anti-Citrullinated Peptides Antibodies (ACPAs), are responsible for the onset of disease and tissue damage. ACPAs appeared early in the disease process and could activate macrophages. In turn, this leads to the release of pro-inflammatory cytokines that stimulate synovial fibroblasts. In this disease, neither autoantibodies, nor leucocytes destroy bone and cartilage. This is caused by aggressive epigenetically modified synovial fibroblasts. Current treatments did not directly target those cells. The term “autoimmune disease” for RA should be used with caution until the link between immune phenomena and joint damage has been elucidated. However, we have to be open and to accept that RA is a heterogeneous disease. This is reflected by the large variability of responses to immunosuppressive drugs or biologicals.
Authors and Affiliations
Stephan Neidhart, Michel Neidhart
Targeted gene therapy in the management of osteoarthritis: back to the future with great expectations
Osteoarthritis (OA) is a degenerative joint disease of the articular cartilage with subchondral bone remodeling and secondary inflammation [1]. OA is the most common joint disease worldwide, a chief cause of chronic disa...
Rheumatologic manifestations of HIV/AIDS
There has been a decline in the prevalence of HIV/AIDS and a decline in AIDS-associated deaths. However, the World Health Organization estimates that roughly 35 million people are living with HIV. Globally, there are sti...
Lower ratings of pain intensity in older adults lead to underestimation of disease activity in patients with rheumatoid arthritis
Background: To investigate the influence of age on the components of the 28-joint Disease Activity Score (DAS28)-C-Reactive Protein (CRP) in patients with Rheumatoid Arthritis (RA) and whether DAS28-CRP can be equally in...
25-hydroxyvitamin D3 deficiency and vitamin D receptor polymorphisms in Egyptian patients with Behçet’s disease: a pilot study
Background: We investigated serum levels of 25-hydroxyvitamin D3 and the vitamin D receptor (VDR) gene polymorphisms (Fokl, Bsml) in Egyptian patients with Behçet’s disease (BD) and their relationship to disease manifest...
A young lady with seronegative systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease. It is a multisystem disease which can involve any organ in the body. Most of the SLE cases are seropositive which depend on positive test f...