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类风湿关节炎的自然病史。

The Natural History of Rheumatoid Arthritis.

机构信息

Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.

Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.

出版信息

Clin Ther. 2019 Jul;41(7):1256-1269. doi: 10.1016/j.clinthera.2019.04.028. Epub 2019 Jun 10.

Abstract

PURPOSE

This article reviews the phases of rheumatoid arthritis (RA) development in terms of the evolution of disease, with a focus on events that occur before the first appearance of clinically apparent inflammatory arthritis. This presynovitis period is defined in individuals who eventually develop classified RA as the pre-RA phase. We include additional discussion of the relevance of this model of RA development to the concept of disease prevention.

METHODS

The information provided in this review was identified through searches of the medical literature through MEDLINE and a review of references from published manuscripts as well as information obtained by the authors through attendance at various conferences and working groups related to pre-RA.

FINDINGS

It is now well established that RA develops in a series of phases. The first of these phases is believed to be the presence of genetic and/or environmental risk factors for RA in the absence of detectable systemic autoimmunity in the blood. After this phase, autoimmunity may be detectable through a variety of means (eg, autoantibodies, autoreactive cells) in peripheral blood; in addition, there is emerging evidence that perhaps initiation and early propagation of RA-related autoimmunity may occur at mucosal sites. The presence of autoimmunity detectable in the blood through serologic or other testing is followed in most individuals by a propagation phase that is characterized by an expansion of autoimmunity, inflammation, and symptoms. This transition may be associated with similar or different genetic and environmental factors that initially triggered autoimmunity, as well as continued mucosal inflammation and local RA-related autoantibody production. Eventually, clinically detectable inflammatory arthritis develops that can be classified as RA.

IMPLICATIONS

Understanding the phases of RA development are critical to the development of preventive strategies for this disease.

摘要

目的

本文回顾了类风湿关节炎(RA)的发展阶段,重点关注在临床上明显的炎症性关节炎出现之前发生的事件。在最终发展为分类 RA 的个体中,这个滑膜炎前阶段被定义为 RA 前期。我们还讨论了这种 RA 发展模型与疾病预防概念的相关性。

方法

本综述中提供的信息是通过 MEDLINE 检索医学文献以及对已发表手稿的参考文献进行综述,并通过作者参加与 RA 前期相关的各种会议和工作组获得的。

发现

现在已经明确,RA 是在一系列阶段中发展的。这些阶段中的第一个阶段被认为是在血液中没有检测到系统性自身免疫的情况下存在 RA 的遗传和/或环境风险因素。在此阶段之后,通过各种手段(例如自身抗体、自身反应性细胞)可能在外周血中检测到自身免疫;此外,有证据表明,RA 相关自身免疫的起始和早期传播可能发生在黏膜部位。通过血清学或其他检测在血液中检测到的自身免疫在大多数个体中随后进入传播阶段,其特征是自身免疫、炎症和症状的扩大。这种转变可能与最初引发自身免疫的类似或不同的遗传和环境因素以及持续的黏膜炎症和局部 RA 相关自身抗体产生有关。最终,可检测到临床上的炎症性关节炎,可将其归类为 RA。

意义

了解 RA 发展的阶段对于开发这种疾病的预防策略至关重要。

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