Peculiarities of the Rheumatoid Arthritis Pathogenesis and Some Current Approaches to Its Treatment.
Rheumatoid arthritis (RA) is one of the most common systemic autoimmune diseases. The present review regards the most important items of RA immunopathogenesis and some of approaches to its treatment. Initiation by a hypothetical antigen causes T lymphocyte activation. T cells stimulate macrophages to produce cytokines, which provide inflammatory and osteodestructive effects, - IL-1, TNF-alpha, GM-CSF, IL-6 and others. TNF-alpha is shown to be of the leading role in the network of the regulatory proteins. The most common patent medication for RA worldwide is the use of anti-inflammatory drugs - steroid and non-steroid. Recent studies suggest relatively prompt involvement of aggressive second line drugs when non-steroid anti-inflammatory treatment is expected to be insufficient, and disease modifying antirheumatic drug use is an integral part of this strategy. Combinations of several drugs are considered to be more effective than monotherapy. A number of immunobiological agents are also being widely used for RA medication - such as recombinant cytokines, especially interferons; oral protein administration-induced tolerance; high doses of immunoglobulins, monoclonal antibodies (mAb) to cell surface antigens and to some cytokines. Employment of non-depleting anti-CD4 mAb have shown promising results. Expedient and efficacious is the use of anti-TNF-alpha agents - mAb and TNF-antagonist TNFR:Fc. Research works are being pursued regarding the mAb-toxin conjugates application within RA treatment as well as gene therapy. Yet the most effective and the least toxic methods are still to be developed.
Kevorkov
Nikolay N.
NN
Institute of Ecology and Genetics of Microorganisms, Ural Branch of Russian Academy of Sciences, Perm, Russia.
Futlik
Dan M.
DM