Die medikament�se Behandlung der rheumatoiden Arthritis

Rheumatoid factor measurement--continuing problems 70 years after discovery

There have been long-standing unpublished differences in rheumatoid factor (RF) results, based on the Royal College of Pathologists of Australasia external quality assurance program. This study compared RF results between two commonly used commercial instruments. Serum samples were exchanged between a laboratory using a Beckman Immage immunonephelometer and another using a Roche Modular immunoturbidimeter. The World Health Organization (WHO) reference standard for RF (W1066) was then used to compare the two methods. The Roche immunoturbidimeter appears to have superior sensitivity. Furthermore, there is significant bias between the two instruments as levels of RF increase. Results from the WHO RF reference preparation correlated most closely with the results from the Roche immunoturbidimeter. Standardization for RF measurement is not optimal and has not been achieved between these two commonly used instruments. This may have clinical implications for patient management.

Approaches to the treatment of early rheumatoid arthritis with disease-modifying antirheumatic drugs

This paper reviews recent approaches to treatment of early rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs (DMARDs). The literature on treatment the early RA published between 1995 and 2007 was accessed through the PubMed database from the National Library of Medicine. Keywords were 'early rheumatoid arthritis', 'disease-modifying antirheumatic drugs', 'biologic agents' and 'combination therapy'. Only results of trials on human subjects that directly measured the effects of DMARDs or biological agents on clinical, laboratory parameters and radiological progression of early RA were selected. Combination therapy suppresses RA activity and radiological progression more effectively than monotherapy. If better control of RA is evident after 3-6 months of treatment with the combination of DMARDs, one must still decide whether to stop the first DMARD, stop the second, or continue with the combination. Combination therapy biological agents (infliximab, adalimumab) with methotrexate and etanercept therapy alone may induce remission in many patients with early RA. It is a method of choice in patients with an adverse prognosis. The main indications for combination therapy 'standard' DMARDs or combination 1 DMARDs with a biological agent are such variables as detection of a shared epitope, increase of concentration of anticyclic citrullinated peptide antibodies, rheumatoid factor, C-reactive protein, 28-joint disease activity score, Sharp score and presence of erosion in joints. The majority of rheumatologists believe that patients with RA should be treated with DMARDs earlier rather than later in the disease process. Further trials should establish the optimal approaches to early RA therapy.

Identification of a CXCR4 antagonist, a T140 analog, as an anti-rheumatoid arthritis agent

Several recent papers support the involvement of an interaction between stromal cell-derived factor-1 (SDF-1/CXCL12) and its receptor, chemokine receptor CXCR4, in memory T cell migration in the inflamed rheumatoid arthritis (RA) synovium. Analogs of the 14-mer peptide T140 were previously found to be specific CXCR4 antagonists that were characterized as not only HIV-entry inhibitors but also anti-cancer-metastatic agents. In this study, a T140 analog, 4F-benzoyl-TN14003, was proven to inhibit CXCL12-mediated migration of human Jurkat cells and mouse splenocyte in a dose-dependent manner in vitro (IC(50)=0.65 and 0.54 nM, respectively). Furthermore, slow release administration by subcutaneous injection (s.c.) of 4F-benzoyl-TN14003 using an Alzet osmotic pump significantly suppressed the delayed-type hypersensitivity response induced by sheep red blood cells in mice, and significantly ameliorated clinical severity in collagen-induced arthritis in mice. As such, T140 analogs might be attractive lead compounds for chemotherapy of RA.