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Med Hypotheses. 2012 Jan;78(1):123-9. doi: 10.1016/j.mehy.2011.10.006. Epub 2011 Nov 1.
The autoimmune disease rheumatoid arthritis (RA) presents difficulty in diagnosis, commonly observed flare ups, polycyclical nature of RA progression, and variable response to therapies. Congruent with multiple causes, literature has documented various infectious agents, environmental factors, physical trauma, silica and food sensitivities as potential causes of RA or RA flares in different populations. We propose that these>36 events can initiate RA or RA flares which complicates treatment decisions. Each pharmaceutical medicine benefits 15-82% of RA patients. Predictive factors are needed. Because the initiating cause of RA or RA flare affects the type of joint damage, initial inflammatory response, adaptive immune response, and potential molecular mimicry, we propose the "RA cause affects response to therapy" (RACART) theory. The potential cause combined with confounding factors such as genetic risk factors, nutritional status, epigenetic status, inflammatory levels, and detoxification ability may help predict responses to various therapies.
自身免疫性疾病类风湿关节炎 (RA) 在诊断上存在困难，通常会出现病情发作，RA 的进展具有多周期性，且对治疗的反应也各不相同。文献中有大量资料表明，多种病原体、环境因素、物理性创伤、二氧化硅和食物过敏等都可能是 RA 或不同人群中 RA 发作的潜在原因。我们认为，这些 >36 种情况都可能引发 RA 或 RA 发作，这使得治疗决策变得复杂。每一种药物都能使 15-82%的 RA 患者受益。因此，我们需要预测性因素。由于引发 RA 或 RA 发作的原因会影响关节损伤的类型、初始炎症反应、适应性免疫反应和潜在的分子模拟，我们提出了“RA 病因影响治疗反应”（RACART）理论。潜在病因结合遗传风险因素、营养状况、表观遗传状态、炎症水平和解毒能力等混杂因素，可能有助于预测对各种治疗方法的反应。
