Reumatoide arthritis (RA) is een ernstige, chronische ontstekingsziekte van de gewrichten. Hoofdstuk 1 is een introductie in epidemiologische gegevens over RA en factoren van invloed op... Show moreReumatoide arthritis (RA) is een ernstige, chronische ontstekingsziekte van de gewrichten. Hoofdstuk 1 is een introductie in epidemiologische gegevens over RA en factoren van invloed op ziektebeloop. Hoofdstuk 2 bespreekt de voorspellende waarde van anti-CCP antistoffen bij patiënten met nog niet te classificeren artritis voor het ontstaan van RA binnen 3 jaar. Deze antistoffen blijken belangrijke voorspellers te zijn voor het ontwikkelen van RA bij deze groep patiënten en een waardevolle aanvulling voor het vroegtijdig stellen van de diagnose RA. Hoofdstuk 3 onderzoekt de voorspellende waarde van de verdeling van ontstoken gewrichten bij eerste polibezoek op de ernst van röntgenologische schade in de toekomst. Artritis van de grote gewrichten vooral van de knie hangt hiermee samen. Hoofdstuk 4 analyseert volledige klinische remissie bij patiënten met RA. In een RA cohort uit Leiden vertoonde 10% blijvende remissie. Deze patiëntengroep werden gekenmerkt door afwezigheid van antistoffen. Hoofdstuk 5 beschrijft een gen-omgevingsinteractie tussen roken en de aanwezigheid van anti-CCP antistoffen bij patiënten met RA die drager zijn van bepaalde HLA klasse II allelen (de shared epitope allelen). Hoofdstuk 6 is een theorie over de oorzaak van de afgenomen incidentie van RA in de afgelopen decennia door een veranderde genetische samenstelling van de populatie. Show less
Genetic factors play an important role in the regulation of human life span but the exact pathways remain to be elucidated, however they may be interrelated with the regulation of human... Show moreGenetic factors play an important role in the regulation of human life span but the exact pathways remain to be elucidated, however they may be interrelated with the regulation of human reproduction. It is argued that an innate cytokine profile supportive of Th1-type T cells favors survival of infectious diseases (with longevity as the ultimate), but women with this profile are found less likely to have successful pregnancies (progeny). The probability of a normal fertility was found to increase more than 10-fold when the innate cytokine profile was characterized by high IL-10 (Th-2 cytokine) and low TNF- (Th-1 cytokine) responsiveness. The IL10 –2849 AA genotype was found to be associated with a decreased fertility and fecundity (time to pregnancy) in females, possibly due to the lower expected IL10 responsiveness. Rheumatoid arthritis (RA) is an example of a Th-1 mediated disease. It was found that the phenotype of joint destruction in RA was associated with the phenotype of reported miscarriages, suggesting common genetic risk factors for each of these two traits, possibly through the innate Th-1/Th-2 phenotype. Factor V Leiden (FVL) is a point mutation in the factor V gene generating a 7-fold increase in incidence of deep vein thrombosis. Specific advantages of the FVL mutation in early pregnancy (implantation) might balance its potentially harmful effects later in life and explain the remarkably high prevalence of this mutation in the general population. Show less
In rheumatoid arthritis, an inflammatory infiltrate accumulates and persists in the synovial membrane. Synovial T cells display a number of particular characteristics. While displaying markers of... Show moreIn rheumatoid arthritis, an inflammatory infiltrate accumulates and persists in the synovial membrane. Synovial T cells display a number of particular characteristics. While displaying markers of recent activation, synovial T lymphocytes respond poorly to mitogenic stimuli and their cytokine production appears to be suppressed both in situ and in vitro. One of the critical hallmarks from synovial T cells is that they suffer from oxidative stress. Oxidative stress in synovial fluid T lymphocytes inhibits T cell receptor (TCR)-dependent phosphorylation of pivotal signaling molecules, required for efficient T cell proliferation, and contributes to severe hyporesponsiveness of these cells. Chronic exposure of T lymphocytes to free radicals produced by activated phagocytic cells at the site of inflammation has been proposed to be the major cause of deregulated redox homeostasis in RA. In this thesis we further investigate the source of free radicals. We demonstrate that the oxidative stress found in synovial T cells is not the result from exogenous sources but originates from (an) intracellular activated oxidase(s). We demonstrate that the oxidase generating ROS in SF T cells is controlled by the small GTPases Ras and Rap1. We show that in synovial T cells Ras can be activated by a variety of cytokines. Rap1 inhibition is induced by direct cell-cell contact of T lymphocytes with antigen presenting cells (APC), and can be prevented by blocking the co-stimulatory T cell receptor CD28 with CTLA-4. Howevever, we did therapy with a nutrient supplement containing high dose anti-oxidants and poly-unsaturated fatty acids did not lead to clinical improvement of RA disease activity, nor therapy with high dose intravenously administered N-acetyl cysteine. Show less
