ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Rheumatologists now seem to accept that early treatment of patients with rheumatoid arthritis with disease-modifying antirheumatic drugs is required if erosions are to be prevented. Methotrexate remains the most popular disease-modifying antirheumatic drug and is used in the most popular combination treatments, although the dose needs to be reduced in the elderly and those with renal dysfunction. The combination of sulfasalazine, methotrexate with reducing high-dose prednisolone, is demonstrated to be cost-effective in patients with rheumatoid arthritis, but although several other combinations have been reported effective in patients with rheumatoid arthritis, most trials do not have the power to provide a definitive answer as to the best combination available, if one exists.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The concept of using hematopoietic stem cell transplantation to treat patients with autoimmune disease was first provided by animal studies and anecdotal case reports. Advances over recent years in autologous hematopoietic stem cell transplantation, most notably cytokine-mobilized peripheral blood stem cells, have been followed by its specific use to treat severe autoimmune and inflammatory diseases. Guidelines have been published, and, by March 1999, 150 cases were registered with the International Autoimmune Disease Stem Cell Project Database. This review summarizes the literature published with respect to inflammatory rheumatic disease over the past few years and discusses future directions aimed at refining this intensive approach.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Most rheumatology textbooks lack adequate recommendations for specific immunization of patients with rheumatic diseases, especially those treated with immunosuppressive medications. The authors wish to alert clinicians to issues pertinent to immunization of immunosuppressed rheumatology patients. By elucidating deficiencies in the current literature, the authors hope to identify future directions for clinical investigation and to increase the rates of effective immunization against vaccine preventable diseases. In addition to focusing on immunizations, this article also discussesPneumocystis cariniiprophylaxis in immunosuppressed patients with rheumatic diseases and screening that clinicians should consider before beginning administration of immunosuppressive agents.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In 1998, further details on the treatment of patients with rheumatoid arthritis with biologic agents became available. Biologic agents with established efficacy, eg, the chimeric tumor necrosis factor-α monoclonal antibody cA2, were tested in combination with methotrexate (MTX), with evidence of synergistic effects. These trials revealed new, important information on the incorporation of tumor necrosis factor-a blocking agents into a treatment regimen of rheumatoid arthritis using established disease-modifying antirheumatic drugs and innovative biologic agents. Clinical trials testing new agents, eg, T-cell receptor peptides in a double-blind, placebo-controlled fashion represented new developments with regard to T cell-directed treatment principles. In addition, new developments in the preclinical phase are discussed.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Fas-mediated apoptosis is observed in synoviocytes of patients with rheumatoid arthritis (RA). This process may be involved in the pathophysiology of RA. We have recently found that Fas-mediated apoptosis of RA synoviocytes is associated with activation of two signaling pathways, the c-Jun amino-terminal kinase (JNK)/activator protein-1 (AP-1) pathway, and the FADD (Fas-associated death domain protein)/Caspase-8/Caspase-3/PARP (poly(ADP-ribose)polymerase) pathway. The latter appears to be one of the major signaling pathways required for Fas-mediated apoptosis in RA synoviocytes. Interestingly, Fas-mediated apoptosis in synoviocytes may be induced at least in part by tumor necrosis factor-a. Paradoxically, tumor necrosis factor-a also causes proliferation of synoviocytes. Employing these molecular processes in the treatment of RA, we have recently shown thatex vivogene transfer of human Fas ligand (hFasL) induced apoptosis of synoviocytes and infiltrated mononuclear cells of RA synovial tissue through cell-to-cell interaction via the Fas/FasL system. We believe that further understanding of the complex regulatory mechanisms of apoptosis in RA synoviocytes would uncover further aspects of the pathophysiologic mechanisms of RA and contribute to the development of new and effective therapies for RA.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There is increasing evidence that distinct signaling and effector pathways in the rheumatoid synovium result in a cascade of pathophysiologic events. These interactions, which finally lead to progressive joint destruction, are different from all other joint diseases in numerous aspects. As outlined in this review, molecular biology techniques allow detection of key pathways ranging from external stimuli to subcellular gene regulation mechanisms operative in various cells within the rheumatoid synovium. To alter these pathways, inhibitory factors need to be applied to these “hot zones” for an extended period, which can be achieved either by repeated drug administration or by local synthesis using genetically altered synovial cells. Both adenovirus and retroviral constructs, as well asex vivoandin vivostrategies, can be used for gene transfer into these cells, and routine delivery of “protective” genes into the affected joints might be achieved within the next decade.

ISSN:1040-8711    

出版商:OVID    

年代:1999

数据来源: OVID