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在类风湿性关节炎的临床前发展中有因果性粘膜驱动因素吗?
1Medicine/Rheumatology, University of Colorado School of Medicine, Aurora, CO United States of America.
Seminars in arthritis and rheumatism
|November 29, 2023
概括
了解类风湿性关节炎 (RA) 的起源是关键. 研究表明,在关节症状出现之前,肠道,肺部和口腔等粘膜部位可能在RA前发挥作用.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 自身免疫性疾病的发病因子
背景情况:
- 血清阳性类风湿性关节炎 (RA) 的发展尚不完全理解,特别是RA前无症状时期.
- 这种RA前阶段的特点是,在临床关节症状出现之前的几年里,RA相关的自身抗体存在.
- 在RA前期确定因果途径对于开发预防性策略对抗炎症性关节炎至关重要.
研究的目的:
- 通过检查系统性和粘膜的变化,审查RA前的潜在因果途径.
- 综合研究对遗传风险个体和在RA前期具有RA相关自身抗体的人的研究结果.
主要方法:
- 对作者和其他研究小组发表的研究进行了审查.
- 分析了专注于粘膜部位 (肠道,肺部,口腔) 和外周血液中的生物标志物的研究.
- 基于审查的文献,建立了关于RA前因果驱动因素的假设.
主要成果:
- 多个粘膜部位,包括肠道,肺部和口腔/牙周区域,在RA前的个人群中显示炎症和局部自身抗体产生 (IgA,IgG,ACPA).
- 这些发现表明RA相关自身免疫的潜在局部起源.
- 关于免疫机制和从局部发现到全身自身免疫和关节炎的演变仍然存在重大问题.
结论:
- 需要进一步进行自然史研究,以阐明粘膜部位在RA发展中的因果作用.
- 来自这些部位的确切免疫路径 (独立,串行或相互关联) 需要进行调查.
- 描述微生物群在局部免疫炎症和自身抗体产生中的作用对于全面了解RA前的作用至关重要.
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