Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
Department of Microbiology and Immunology, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
Int J Mol Sci. 2019 Mar 16;20(6):1332. doi: 10.3390/ijms20061332.
Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease of unknown etiology. It is characterized by the presence of rheumatoid factor and anticitrullinated peptide antibodies. The orchestra of the inflammatory process among various immune cells, cytokines, chemokines, proteases, matrix metalloproteinases (MMPs), and reactive oxidative stress play critical immunopathologic roles in the inflammatory cascade of the joint environment, leading to clinical impairment and RA. With the growing understanding of the immunopathogenic mechanisms, increasingly novel marked and potential biologic agents have merged for the treatment of RA in recent years. In this review, we focus on the current understanding of pathogenic mechanisms, highlight novel biologic disease-modifying antirheumatic drugs (DMRADs), targeted synthetic DMRADs, and immune-modulating agents, and identify the applicable immune-mediated therapeutic strategies of the near future. In conclusion, new therapeutic approaches are emerging through a better understanding of the immunopathophysiology of RA, which is improving disease outcomes better than ever.
类风湿关节炎（RA）是一种病因不明的慢性、炎症性自身免疫性疾病。其特征是存在类风湿因子和抗瓜氨酸肽抗体。在各种免疫细胞、细胞因子、趋化因子、蛋白酶、基质金属蛋白酶（MMPs）和活性氧化应激之间的炎症过程交响乐中，在关节环境的炎症级联反应中发挥着关键的免疫病理作用，导致临床损伤和 RA。随着对免疫发病机制的认识不断加深，近年来，越来越多的新型有标记和潜在的生物制剂被用于治疗 RA。在这篇综述中，我们重点关注发病机制的最新认识，强调新型生物疾病修饰抗风湿药物（DMRADs）、靶向合成 DMRADs 和免疫调节剂，并确定未来不久可应用的免疫介导治疗策略。总之，通过更好地了解 RA 的免疫病理生理学，新的治疗方法正在出现，这比以往任何时候都能更好地改善疾病结局。
