Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis
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| Názov: | Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis |
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| Autori: | Stephen Eyre, Dennis McGonagle, Maya H Buch |
| Zdroj: | Buch, M H, Eyre, S & McGonagle, D 2021, 'Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis', Nature Reviews. Rheumatology, vol. 17, no. 1, pp. 17-33. https://doi.org/10.1038/s41584-020-00541-7 |
| Informácie o vydavateľovi: | Springer Science and Business Media LLC, 2020. |
| Rok vydania: | 2020 |
| Predmety: | Epigenomics, Drug Resistance, Antirheumatic Agents/adverse effects, Inflammation/diagnosis, Arthritis, Rheumatoid, 03 medical and health sciences, Arthritis, Rheumatoid/classification, Sex Factors, 0302 clinical medicine, Tumor Necrosis Factor Inhibitors/therapeutic use, Humans, Janus Kinase Inhibitors, Molecular Targeted Therapy, Treatment Failure, Inflammation, Synovitis, Janus Kinase Inhibitors/therapeutic use, Synovitis/diagnosis, Epigenomics/methods, Genomics, Receptors, Interleukin-6, 3. Good health, Phenotype, Antirheumatic Agents, Receptors, Interleukin-6/antagonists & inhibitors, Tumor Necrosis Factor Inhibitors, Molecular Targeted Therapy/methods |
| Popis: | Despite nearly three decades of advances in the management of rheumatoid arthritis (RA), a substantial minority of patients are exposed to multiple DMARDs without necessarily benefitting from them; a group of patients variously designated as having 'difficult to treat', 'treatment-resistant' or 'refractory' RA. This Review of refractory RA focuses on two types of patients: those for whom multiple targeted therapies lack efficacy and who have persistent inflammatory pathology, which we designate as persistent inflammatory refractory RA (PIRRA); and those with supposed refractory RA who have continued disease activity that is predominantly independent of objective evidence of inflammation, which we designate as non-inflammatory refractory RA (NIRRA). These two types of disease are not mutually exclusive, but identifying those individuals with predominant PIRRA or NIRRA is important, as it informs distinct treatment and management approaches. This Review outlines the clinical differences between PIRRA and NIRRA, the genetic and epigenetic mechanisms and immune pathways that might contribute to the immunopathogenesis of recalcitrant synovitis in PIRRA, and a possible basis for non-inflammatory symptomatology in NIRRA. Future approaches towards the definition of refractory RA and the application of single-cell and integrated omics technologies to the identification of refractory RA endotypes are also discussed. |
| Druh dokumentu: | Article |
| Jazyk: | English |
| ISSN: | 1759-4804 1759-4790 |
| DOI: | 10.1038/s41584-020-00541-7 |
| Prístupová URL adresa: | https://pubmed.ncbi.nlm.nih.gov/33293696 https://www.nature.com/articles/s41584-020-00541-7.pdf https://pubmed.ncbi.nlm.nih.gov/33293696/ https://www.nature.com/articles/s41584-020-00541-7 https://www.ncbi.nlm.nih.gov/pubmed/33293696 |
| Rights: | Springer TDM |
| Prístupové číslo: | edsair.doi.dedup.....82ab33bbd6a24a93a71567d26b45e134 |
| Databáza: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Despite nearly three decades of advances in the management of rheumatoid arthritis (RA), a substantial minority of patients are exposed to multiple DMARDs without necessarily benefitting from them; a group of patients variously designated as having 'difficult to treat', 'treatment-resistant' or 'refractory' RA. This Review of refractory RA focuses on two types of patients: those for whom multiple targeted therapies lack efficacy and who have persistent inflammatory pathology, which we designate as persistent inflammatory refractory RA (PIRRA); and those with supposed refractory RA who have continued disease activity that is predominantly independent of objective evidence of inflammation, which we designate as non-inflammatory refractory RA (NIRRA). These two types of disease are not mutually exclusive, but identifying those individuals with predominant PIRRA or NIRRA is important, as it informs distinct treatment and management approaches. This Review outlines the clinical differences between PIRRA and NIRRA, the genetic and epigenetic mechanisms and immune pathways that might contribute to the immunopathogenesis of recalcitrant synovitis in PIRRA, and a possible basis for non-inflammatory symptomatology in NIRRA. Future approaches towards the definition of refractory RA and the application of single-cell and integrated omics technologies to the identification of refractory RA endotypes are also discussed. |
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| ISSN: | 17594804 17594790 |
| DOI: | 10.1038/s41584-020-00541-7 |