你不了解类风湿性关节炎的10件事

“这可能是风湿病学家如何看待RA以及别人如何看待它的最大差异，”Tohlejo，CA骨质医学学院风湿病教授豪索·费因伯格·霍华德“大多数人认为RA作为关节炎疾病，也使所有这些其他事情发生如心脏或肺部问题。”但事实上，他说，Ra导致免疫系统几乎攻击身体的各个部分 - 心脏，肺，眼睛，皮肤，肝脏，肾脏等 - 它以不同的方式表现出不同的方式。“我们的遗传学可能是导致疾病出现不同的原因，但这仍然是我们正在研究的理论，”说。费因伯格博士。

One sign of RA is higher levels of certain antibodies—rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP)—which indicate the immune system is working in overdrive. But the blood tests for RF and anti-CCP simply aren’t that sensitive, so they don’t detect the antibodies when levels are low. “Anti-CCP has a sensitivity of only 60%, which means that 40% of patients with RA will have a negative test,” says Dr. Feinberg. Rheumatoid factor is even less accurate—it’s positive in only 40% of patients with early disease. “Patients with negative tests, called seronegative RA, still have RA and require the same treatment as patients with a positive test (seropositive RA). Seronegative RA is a little less aggressive, but it can still cause all of the same problems,” says Dr. Feinberg.

当专家注意到类风湿性关节炎和牙龈疾病似乎齐头并进，怀疑口腔细菌会出现。最近由约翰霍普金斯大学研究人员确认了该链接，特别是特别是一个口腔细菌 -刺激杆菌菌诱导术—triggered an overproduction of antibodies that create inflammation and attack joints in RA patients. But as Dr. Feinberg explains, this itself can lead to gum disease, so it’s also possible that RA is causing the gum disease. “We know there’s a link between gum disease and overall health, but we're still in our infancy of understanding human bacteria and its relationship to diseases.”

如果您在迄今为止utis的utis占据过您的ra诊断的岁月上有超过您的公平份额，那么它就没有巧合。最近的一项研究风湿性和肌肉骨骼疾病found that RA patients experienced significantly more urinary tract, genital, and general viral and bacterial infections in the six years prior to their diagnosis. Though more research is needed, researchers suggest that frequent infections could serve as a signal to watch for RA development.

No doubt you’ve heard that many women’s RA symptoms improve during pregnancy. (In fact, up to 40% of pregnant women may achieve remission, according to a research review in开放访问风湿病学。) But did you know that this trend led researchers to a new treatment for RA? “Steroids were actually discovered when a rheumatologist at Mayo Clinic saw that pregnant women with RA got better and figured it must be something they produced, and he found it was cortisol,” says David Pisetsky, M.D., professor of medicine and immunology at Duke University Medical Center. Indeed, women’s levels of cortisol, a steroid hormone, increase significantly during pregnancy. “Ultimately, that’s how prednisone became a treatment for RA.”

Pregnancy might have some protective powers for women with existing RA, but having a baby can unfortunately also set off the disease in others. “The research has shown a 20-fold increase in the risk of developing rheumatoid arthritis within the first year of pregnancy,” says Dr. Feinberg. Female hormonal factors are a primary suspect, but the science is far from conclusive. “The theory is that these women were prone to rheumatoid arthritis and probably would have developed it anyway, but the effects of pregnancy triggered it sooner,” says Dr. Feinberg.

Rheumatoid arthritis treatments that are designed to suppress the immune system can leave patients more vulnerable to infection—including those from weakened disease-causing strains used in live-attenuated vaccines. In other words, a live vaccine can cause the very infection it’s intended to prevent in RA patients. “Fortunately, the number of live vaccines that adults need to take is fairly limited,” says Anca Askanase, M.D., director of rheumatology clinical trials at Columbia University Irving Medical Center in New York City. For instance, the intranasal influenza vaccine is a live vaccine, but the regular flu shot is not. “Other live vaccines include measles, mumps, rubella, and yellow fever. If you really need those, work with your doctor to get off the immunosuppressants long enough to allow for a good response.”

That’s not to say genetics aren’t a factor—they certainly play a role. “We know there is a specific gene, HLA-DRB1, that increases the likelihood of developing rheumatoid arthritis, but this isn’t a disease where if you have the gene, you’re automatically going to get it,” says Dr. Feinberg. In fact, a research review in过敏与免疫学的临床评论估计基因对遗传性的贡献仅为11％至37％。键也是环境触发器，或者转变该基因并开始的东西。“我们知道其中一个触发器是吸烟;“许多研究人员也在寻找非常具体的化学品，污染物，病毒和其他环境因素，”Feinberg博士说。

当您认为RA导致身体的所有组织中炎症时，它有意义的心血管系统受到影响 - 但程度仍然是令人震惊的。“Rheumatoid arthritis increases your risk of heart disease甚至超过糖尿病，“Feinberg博士说。即使在没有预先存在的风险因素的人中，这也是如此，因为RA本身是一种危险因素。“与RA相关的炎症会导致动脉的动脉粥样硬化或硬化，它降低了HDL或良好胆固醇的水平，”Feinberg博士解释说。幸运的是，治疗RA可以降低心脏病，心脏病发作和中风的风险，再次强调停留在管理疾病的重要性。