Introduction: Effective treatment of rheumatoid arthritis (RA) requires suppression of the underlying inflammation. Measurement of such inflammation, the disease activity, is mandatory to target treatment and maximize outcomes. However, this is not as straightforward as it may seem.
Areas covered: The many tools developed to measure disease activity in RA, from composite scores and patient-reported outcomes, to laboratory markers and imaging are discussed, with a focus on their utility in guiding therapy and assessing response. The complex issues in measuring disease activity in RA, whether in clinical trials or normal clinical practice, and in the context of national guidelines and recommendations, available time, and resources are considered.
Expert commentary: The key to effective management of RA is the rapid suppression of inflammation, ideally to remission, with maintenance of such remission. The aim is to prevent disability and maximize quality of life. Central to this is the ability to determine disease activity (potentially open to suppression) as opposed to damage (irreversible). A variety of measures are currently available, allowing better assessment of response to treatment. In the future, the development of predictive biomarkers allowing targeting of drugs may revolutionize this field and render the tools of today redundant. 相似文献
Microvascular involvement represents one of the first apparent steps in many autoimmune diseases such as rheumatoid arthritis (RA). Early in the disease, peripheral microangiopathy may be easily recognized and studied by videocapillaroscopy. The aim of this study has been to observe the differences in labial microcirculation between healthy patients and patients suffering from RA. A total of 30 healthy patients and 30 patients suffering from RA were examined. The patients with conditions known to compromise microcirculation, such as diabetes, hypertension, or some pharmacological treatments were not included in the study. All the patients were non-smokers. Labial capillaroscopy was used to investigate the characteristics of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhages, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. The investigation was simple, non-invasive, and repeatable for each patient. In patients suffering from RA, it was possible to observe a reduced caliber of capillaries, as well as greater elongated capillaries, in comparison to controls. This study shows that capillary alterations in patients suffering from RA occur in labial mucosa microcirculation; such evidence could be extremely important in the diagnosis of suspected RA. 相似文献
Despite the use of gold complexes in modern medicine for over 100 years and the use of gold complexes in the management of
rheumatoid disease for more than 60 years, the definitive mechanisms of action for efficacy and for toxicity have not been
established.
Gold is a group 1b metal in the periodic table with several oxidation states but it is only Au(I) which is active in the biological
milieu. Gold sodium thiomalate is not only a polymeric structure, but also has the chiral ligand, thiomalic acid. Gold sodium
thiomalate thus can exist in several different physical states which may have different biological activity. In addition the
pharmacokinetic profile of gold complexes has been of little value in the understanding of either the mechanism of action,
efficacy or toxicity for both the injectable and the oral gold complexes. Many authors have misinterpreted research data on
the activities of gold complexes because they compared gold complexes of different structures, and gold complexes which exist
at different pH.
Experimental work in our laboratory has identified that gold sodium thiomalate is a mixture and can exist as either a yellow
or a colourless solution. These have some similar but several different biological activities.
Many factors contribute to the lack of understanding of the action of gold complexes. Some of these factors are related to
the wide variation in physical structure and biological activities exhibited by these compounds. 相似文献