Rheumatoid arthritis as autoimmune disease Essay

Rheumatoid arthritis (RA) is a systemic autoimmune disease, characterized by synovial inflammation of multiple joints leading to joint damage and disability. The etiology of RA though not completely understood yet, thus it is considered multifactorial and genetic factors as well as various environmental and life style risk factors are involved. During recent years the incidence of RA has increased. The cause of this increasing is unknown, but it appears likely that environmental or life style factors account for this increase in a relatively short period of time.
Female sex and older age are known risk factors for rheumatoid arthritis (RA). The disease is however, heterogeneous and a common division occurs between the presence/absence of autoantibodies to citrullinated peptide antigens (ACPA) where ACPA-positive disease generally has a worse outcome. Established genetic HLA-DRB1 SE alleles and environmental (smoking) risk factors are also predominantly associated with the risk of ACPA-positive RA
Rheumatoid factor (RF) has long been a component of the diagnostic criteria for rheumatoid arthritis (RA) [1]. Although the sensitivity of RF is approximately 75-80%, with specificity is modest. RF is found in 3-5% of the general population, and in up to 30% of the elderly [2]. Despite this limitation, RF is well studied and its associations with a more severe disease course have been extensively described. High RF concentrations, are associated with unremitting disease, in addition to the presence of subcutaneous nodules and other extra-articular disease manifestations [3, 4].
Recently, anti-cyclic citrullinated peptide antibody (ACCP) has been shown to be reasonably sensitive (65-80%) and highly specific for RA (up to 98%) [2, 5, 6]. Not only ACCP is useful in diagnosis, also its presence has been shown to predate clinical disease by several years in some instances, and it is useful in identifying those with undifferentiated arthritis who would eventually develop RA [7]. Moreover, aCCP status provides important prognostic information of RA. Numerous studies have shown that aCCP positivity is associated with joint damage and radiographic progression [8-10] and Rnnelid et al.(year) showed that aCCP seropositive patients had more active disease during follow-up than seronegative patients [11]. However, only a small number of studies have considered the magnitude of aCCP concentrations, rather than qualitative aCCP status (seropositive or seronegative), and none have examined the prognostic value of aCCP in a predominantly male cohort of RA patients.
Anti-CCP antibody levels have been reported to be associated with high disease activity scoring at 28 joints (DAS28) values in RA patients.11
Immunological processes are humoral or cell-mediated responses from the immune system to pathogenes or endogenous antigens as it occurs in autoimmune diseases such as RA. Besides others, immunological responses include blood and cell expressions, such as C-reactive protein(CRP)levels or number of CD4+ T cells (Calder, 2007). Some of these are of particular interest due to the findings of previous studies, which indicated a potential effect of certain activities on cytokine and CRP levels. Physical activity could impact CRP and interleukin 6 (IL-6) levels (Nader and Lundberg, 2009), and mediate CD4+ T lymphocyte levels (Creswell et al., 2009).