Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
Deutsches Zentrum fur Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
Nat Rev Rheumatol. 2021 Mar;17(3):135-144. doi: 10.1038/s41584-020-00543-5. Epub 2020 Dec 10.
Cure is the aspirational aim for the treatment of all diseases, including chronic inflammatory conditions such as rheumatoid arthritis (RA); however, it has only been during the twenty-first century that remission, let alone cure, has been a regularly achievable target in RA. Little research has been carried out on how to cure RA, and the term 'cure' still requires definition for this disease. Even now, achieving a cure seems to be a rare occurrence among individuals with RA. Therefore, this Review is aimed at addressing the obstacles to the achievement of cure in RA. The differences between remission and cure in RA are first defined, followed by a discussion of the underlying factors (referred to as drivers) that prevent the achievement of cure in RA by triggering sustained immune activation and effector cytokine production. Such drivers include adaptive immune system activation, mesenchymal tissue priming and so-called 'remote' (non-immune and non-articular) factors. Strategies to target these drivers are also presented, with an emphasis on the development of strategies that could complement currently used cytokine inhibition and thereby improve the likelihood of curing RA.
治愈是治疗所有疾病的理想目标，包括类风湿关节炎（RA）等慢性炎症性疾病；然而，直到 21 世纪，缓解（更不用说治愈）才成为 RA 经常可以实现的目标。关于如何治愈 RA 的研究很少，而且对于这种疾病，“治愈”一词仍需要定义。即使是现在，在 RA 患者中，治愈似乎也很少见。因此，本综述旨在探讨 RA 中实现治愈的障碍。首先定义 RA 中缓解和治愈之间的差异，然后讨论阻止 RA 实现治愈的潜在因素（称为驱动因素），这些驱动因素通过触发持续的免疫激活和效应细胞因子产生来阻止治愈。这些驱动因素包括适应性免疫系统激活、间充质组织启动和所谓的“远程”（非免疫和非关节）因素。还提出了针对这些驱动因素的策略，重点是开发可以补充目前使用的细胞因子抑制的策略，从而提高治愈 RA 的可能性。
