Is Rheumatoid Arthritis a Life Sentence?

By Dr. John A. Lopes

Forty years ago, Joe was an avid athlete with muscular body that could marvel Greek god Apollo. Today he is no longer is active and is virtually home bound. He struggles to hold a cup of coffee with his hand. He has severe rheumatoid arthritis (RA) with severe joint pain. RA has limited his movement.

Rheumatoid arthritis is a chronic inflammatory disorder that can cause pain, swelling, stiffness, and loss of function in the finger, wrist, and other joints throughout the body. It occurs when the immune system mistakenly attacks the body’s own tissue, such as the membranes that line the joints.

 Although RA occurs more common with advanced age, anyone can experience this disease. Drs. Soumya Raychaudhuri M.D., Ph.D. and Michael Brenner M.D. at Brigham and Women’s Hospital, Jennifer Anolik M.D., Ph.D. at the University of Rochester, and Laura Donlin the Hospital for Special Surgery in New York examined synovium, a thin tissue that lines joints.

Dr. Donlin’s team investigated the process of inflammation in tissue culture. The cells included both macrophages and fibroblasts cell. The fibroblast cells make joint tissue. The macrophages signal fibroblasts through a growth factor called HB-RGF to destroy joint tissue. The growth factor attaches to a receptor called EGFR present on the cells. The team of researchers found that an experimental anti-cancer drug can block the attachment and prevent the destructive process that could potentially lead to the prevention or cure of RA.

The inflammation of the joints can also be prevented by using immune suppressive drugs. However immune suppressive drugs can block natural resistance to infective agents. Dr. Dan Littman M.D., Ph.D. of NYU School of Medicine has reported that there is some correlation between RA and gut microbes. The researchers found that 75% of people with new-onset, untreated rheumatoid arthritis had the bacterium Prevotella copri in their intestinal microbiome. Increased levels of P. copri correlated with reductions in several groups of beneficial microbes, such as Bacteroides. The researchers performed more complete DNA sequencing on a subset of samples and identified unique Prevotella bacterial genes that correlated with rheumatoid arthritis. Mice were then given a chemical that induced colitis, a model of gut inflammation. Animals with P. copri developed more severe symptoms than the mice that hadn’t received the bacteria. Thus, RA is a complex disorder and requires multiple solutions.

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