Year: 2015
Type: dissertation
Abstract: __Abstract__ \n \nRheumatoid arthritis (RA) is a systemic auto-immune disease mainly characterized by articular \nmanifestations [1]. Patients present initially with synovitis and joint damage, while extra-articular \nmanifestations such as vasculitis, pleuritis and pericarditis are manifestations of severe or longstanding \ndisease [1,2]. The prevalence of RA is approximately 1% [2]. It affects most patients in the fifth decade of \nlife with females more affected than males [2]. The etiopathogenesis is not fully understood. Genetic, \nepigenetic and environmental factors seem to play a role [3,4]. \nBefore the articular manifestations other features of RA can already be present. Nielen et al \nshowed in a retrospective cohort of RA patient that donated blood that 49% of the patients were \npositive for anti-citrullinated protein antibody’s (ACPA’s) and rheumatoid factor (RF) up to 15 years \nbefore onset of symptoms [5]. This suggests that the disease develops in different stages which \nwas recently depicted by Hazes and Luime [6,7]. They illustrated RA as stages of plant growth, see \nfigure 1. In the pre-articular phase, all the genetic potential for the development of RA is present, but \nthere are no signs or symptoms of disease. This stage can than develop into an arthralgia phase in \nwhich clinically objective synovitis is still not present. In the first clinical phase, symptoms and signs \nof synovitis indicate the presence of inflammatory arthritis but the form of arthritis is not classifiable \nand the arthritis is hardly discernable from other inflammatory rheumatic diseases. In the next clinical \nphase, the disease develops and shows more features of its definite form, and in the third clinical \nphase the arthritis is fully classifiable as RA [6].
Author: Celina Alves
Institution: Erasmus MC
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1138349880