A possible new phase for rheumatoid arthritis treatment

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BioMed Central 07.04.2005

A possible new phase for rheumatoid arthritis treatment

The pathology of rheumatoid arthritis within the first few months after

symptom onset is distinct from that of the early phases of other

inflammatory joint diseases and also of established rheumatoid

arthritis. New research published today in Arthritis Research & Therapy

found that very early rheumatoid arthritis is characterised by a

distinct profile of T cell, macrophage and stromal cell related

cytokines in synovial fluid.

This finding of a distinct phase of rheumatoid arthritis, immediately

after the onset of clinical symptoms, provides a new rationale for the

very early treatment of rheumatoid arthritis - before the disease

develops into a long-term condition.

The synovium, the connective tissue membrane that lines the joints, is

the primary site of pathology in rheumatoid arthritis. Although the

processes that maintain long-term inflammation of the synovium in

rheumatoid arthritis have been well studied, those initiating the

inflammation have not, and very few groups have studied the pathology

of rheumatoid arthritis within the first few weeks after the onset of

symptoms.

Karim Raza and colleagues, from the University of Birmingham, U.K.,

investigated the processes occurring in the joints of patients within 3

months of the onset of clinical symptoms. They assessed a panel of T

cell, macrophage and stromal cell related cytokines and chemokines in

synovial fluid samples from inflamed joints of these patients with very

early arthritis. Patients who eventually developed persistent

rheumatoid arthritis had a cytokine profile that was different from

that seen in patients in the early phases of other arthritic diseases,

and also from that in longstanding rheumatoid arthritis - suggesting a

distinct pathological process during the early phase of rheumatoid

arthritis.

Rheumatoid arthritis is a common, serious and disabling autoimmune

disease in which inflammation of the joint lining (or synovium) results

when the body’s tissues are mistakenly attacked by the immune system.

Approximately eight million people are affected by rheumatoid arthritis

in the UK.

Raza and colleagues speculate that the cytokines present in very early

rheumatoid arthritis may be involved in the development of the

microenvironment required for chronic disease. The authors propose that

there is now a strong biological rationale for testing the effects of

potent anti-inflammatory therapies during the first few months of

clinically apparent disease. " The pathologically distinct nature of the

very early phase of clinically apparent rheumatoid arthritis suggests

that this phase may represent a therapeutic window " , said Dr Karim

Raza.

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