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Over the last several decades, research
has greatly increased our understanding of immunology, genetics,
and cellular and molecular biology. This foundation in basic
science is now showing results in several areas important
to rheumatoid arthritis. Scientists are thinking about rheumatoid
arthritis in exciting ways that were not possible even 10
years ago.
The National Institutes of Health funds a wide
variety of medical research at its headquarters in Bethesda,
Maryland, and at universities and medical centers across the
United States. One of the NIH institutes, the National Institute
of Arthritis and Musculoskeletal and Skin Diseases, is a major
supporter of research and research training in rheumatoid
arthritis through grants to individual scientists, Specialized
Centers of Research, and Multipurpose Arthritis and Musculoskeletal
Diseases Centers.
Following are examples of current research directions
in rheumatoid arthritis supported by the Federal Government
through the NIAMS and other parts of the NIH.
Scientists are looking at basic abnormalities
in the immune systems of people with rheumatoid arthritis
and in some animal models of the disease to understand why
and how the disease develops. Findings from these studies
may lead to precise, targeted therapies that could stop the
inflammatory process in its earliest stages. They may even
lead to a vaccine that could prevent rheumatoid arthritis.
Researchers are studying genetic factors that
predispose some people to developing rheumatoid arthritis,
as well as factors connected with disease severity. Findings
from these studies should increase our understanding of the
disease and will help develop new therapies as well as guide
treatment decisions. In a major effort aimed at identifying
genes involved in rheumatoid arthritis, the NIH and the Arthritis
Foundation have joined together to support the North American
Rheumatoid Arthritis Consortium. This group of 12 research
centers around the United States is collecting medical information
and genetic material from 1,000 families in which two or more
siblings have rheumatoid arthritis. It will serve as a national
resource for genetic studies of this disease.
Scientists are also gaining insights into the
genetic basis of rheumatoid arthritis by studying rats with
autoimmune inflammatory arthritis that resembles human disease.
NIAMS researchers have identified several genetic regions
that affect arthritis susceptibility and severity in these
animal models of the disease, and found some striking similarities
between rats and humans. Identifying disease genes in rats
should provide important new information that may yield clues
to the causes of rheumatoid arthritis in humans.
Scientists are studying the complex relationships
among the hormonal, nervous, and immune systems in rheumatoid
arthritis. For example, they are exploring whether and how
the normal changes in the levels of steroid hormones (such
as estrogen and testosterone) during a person's lifetime may
be related to the development, improvement, or flares of the
disease. Scientists are also looking at how these systems
interact with environmental and genetic factors. Results from
these studies may suggest new treatment strategies.
Researchers are exploring why so many more women
than men develop rheumatoid arthritis. In hopes of finding
clues, they are studying female and male hormones and other
elements that differ between women and men, such as possible
differences in their immune responses.
To find clues to new treatments, researchers are
examining why rheumatoid arthritis often improves during pregnancy.
Results of one study suggest that the explanation may be related
to differences in certain special proteins between a mother
and her unborn child. These proteins help the immune system
distinguish between the body's own cells and foreign cells.
Such differences, the scientists speculate, may change the
activity of the mother's immune system during pregnancy.
A growing body of evidence indicates that infectious
agents, such as viruses and bacteria, may trigger rheumatoid
arthritis in people who have an inherited predisposition to
the disease. Investigators are trying to discover which infectious
agents may be responsible. More broadly, they are also working
to understand the basic mechanisms by which these agents might
trigger the development of rheumatoid arthritis. Identifying
the agents and understanding how they work could lead to new
therapies.
Scientists are searching for new drugs or combinations
of drugs that can reduce inflammation, can slow or stop the
progression of rheumatoid arthritis, and also have few side
effects. Studies in humans have shown that a number of compounds
have such potential. For example, some studies are breaking
new ground in the area of "biopharmaceuticals", or "biologics".
These new drugs are based on compounds occurring naturally
in the body, and are designed to target specific aspects of
the inflammatory process.
Investigators have also shown that treatment of
rheumatoid arthritis with minocycline, a drug in the tetracycline
family, has a modest benefit. The effects of a related tetracycline
called doxycycline are under investigation. Other studies
have shown that the omega-3 fatty acids in certain fish or
plant seed oils also may reduce rheumatoid arthritis inflammation.
However, many people are not able to tolerate the large amounts
of oil necessary for any benefit.
Investigators are examining many issues related
to quality of life for rheumatoid arthritis patients and quality,
cost, and effectiveness of health care services for these
patients. Scientists have found that even a small improvement
in a patient's sense of physical and mental well-being can
have an impact on his or her quality of life and use of health
care services. Results from studies like these will help health
care providers design integrated treatment strategies that
cover all of a patient's needs--emotional as well as physical.
Hope
for the Future
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