The field of rheumatoid arthritis (RA) is moving into identification of patients as early as possible and the ultimate aim is to prevent RA becoming a chronic disease. To this end, we studied the... Show moreThe field of rheumatoid arthritis (RA) is moving into identification of patients as early as possible and the ultimate aim is to prevent RA becoming a chronic disease. To this end, we studied the phase of Clinically Suspect Arthralgia (CSA). Patients with arthralgia that were considered by the rheumatologist to have an increased risk to progress to RA (CSA) had indeed an increased risk of RA. In addition, subclinical MRI-inflammation preceded clinical arthritis with a few months. Future research will shed more light on processes underlying progression from CSA to RA and effectiveness of treatment initiation in the CSA phase. The severity of the course of RA is variable between patients and this cannot be yet accurately predicted. In this thesis, we performed studies that contributed to the understanding of these differences in severity. Three genetic risk factors for more severe joint damage progression (two non-HLA and one HLA variation) and one for arthritis persistence were identified. Further research on functional implications of the identified variants and whether they might be useful as biomarkers to guide treatment decisions is needed. Show less
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease leading to destruction of cartilage and bone. The inflammation in the joints is mainly caused by inflammatory cytokines that are... Show moreRheumatoid arthritis (RA) is a chronic inflammatory joint disease leading to destruction of cartilage and bone. The inflammation in the joints is mainly caused by inflammatory cytokines that are over-produced by various types of immune cells. Artritis is an autoimmune disease that is characterized by the presence of autoantibodies. These autoantibodies form immune complexes (IC) which are other important players in joint inflammation because they activate various immune cells by binding to Fc receptors (FcR). Binding and activation of FcRs initiates intracellular signaling that triggers activation and release of various inflammatory mediators. In this thesis we describe a variety of aspects of arthritis research that has been performed to get a better understanding of the underlying molecular and cellular disease mechanisms and to develop novel therapeutic strategies. Show less
Suurmond, J.; Velden, D. van der; Kuiper, J.; Bot, I.; Toes, R.E.M. 2016
The first part is focused on early recognition of Rheumatoid Arthritis (RA). Two large early arthritis recognition clinics were started in Leiden and Groningen. The results showed that this... Show moreThe first part is focused on early recognition of Rheumatoid Arthritis (RA). Two large early arthritis recognition clinics were started in Leiden and Groningen. The results showed that this initiative reduces the GP-delay significantly. Secondly, it was investigated whether an association between shorter symptom duration and a beneficial outcome in RA exists. Furthermore, it was questioned whether there was a confined period in which the start of DMARD therapy has a more beneficial effect. In the third part of the thesis certain disease features/ symptoms were investigated in more detail to assess if they had a prognostic or diagnostic value in arthralgia, early arthritis or RA patients. Finally, in the last part focused on mortality in RA. It was observed that patients that were treated early and with aggressive DMARD therapy had no increased mortality compared to the Dutch general population. In conclusion, the current thesis showed that lots of progress was made in the attempt to recognize rheumatoid arthritis earlier, that a therapeutic window of opportunity exits and that with prompt initiation of adequate DMARD-treatment RA should no longer be tagged as a chronic condition but that drug-free remission and improved survival are both achievable goals. Show less
Brink, M.; Hansson, M.; Mathsson-Alm, L.; Wijayatunga, P.; Verheul, M.K.; Trouw, L.A.; ... ; Rantapaa-Dahlqvist, S. 2016
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that principally affects synovial joints. RA is present in 0,5% to 1% of the global population. The incidence of RA is higher in... Show moreRheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that principally affects synovial joints. RA is present in 0,5% to 1% of the global population. The incidence of RA is higher in women than in men and increases with age (1). RA can affect any joint but preferably small joints in hands and feet (2). The symptoms of RA include pain, swelling, stiffness, redness, warmth and can finally lead to loss of joint functions (2). The systemic symptoms of RA include fatigue, malaise, loss of appetite and muscle ache. Next to the joints RA can affect other organs such as skin, lungs, heart and blood vessels (3). RA can be classified using the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis (2010 ACR/EULAR criteria) (4). This is a quantitative system in which scores can be obtained from: joint involvement, serologic markers, inflammation markers and duration of symptoms (4). Show less
