Immunologic rheumatic disorders.
We provide the basics for clinicians who might be called on to consider the diagnosis of diseases such as systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) in their practice. We will emphasize clinical recognition and first-line laboratory testing. Only characteristics of the classic rheumatic inflammatory diseases (ie, RA, seronegative spondyloarthropathy, SLE, antiphospholipid syndrome, Sjögren syndrome, scleroderma, and polymyositis/dermatomyositis) will be covered. In the past decade, treatment for RA and seronegative spondyloarthropathy has substantially improved. Their treatment has been revolutionized by the use of methotrexate and, more recently, TNF inhibitors, T-cell costimulation modulators, and B-cell depletion. The goal of RA treatment today is to induce a complete remission as early as possible in the disease process, with the mantra being "elimination of synovitis equals elimination of joint destruction." The hope is that if the major mediators of Sjögren syndrome, SLE, or scleroderma can be identified and then blocked, as in the example of TNF inhibitors in patients with RA, more specific treatments will become available. Thus RA has become an excellent model of this evolving paradigm. Through the identification of major mediators in its pathogenesis, novel and highly efficacious therapeutic agents have been developed.
Joseph
Amy
A
Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St Louis, MO 63110, USA.
Brasington
Richard
R
Kahl
Leslie
L
Ranganathan
Prabha
P
Cheng
Tammy P
TP
Atkinson
John
J
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000378:metabolism; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D009928:Organ Specificity; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D012737:Sex Factors
D000893:Anti-Inflammatory Agents; D001323:Autoantibodies