Hopp til innhold
NHI.no
Annonse
Informasjon

Moderne forskning på leddgikt og fremtidspektiv

Høy forskningsaktivitet de siste tiårene gjør at vi vet stadig mer om leddgikt. Mer kunnskap vil kunne gi nye metoder for å angripe sykdommen ved hjelp av medisiner.

Mikropskop

Sist oppdatert:

22. mai 2019

Høy forskningsaktivitet

I løpet av de siste tiårene har vår kunnskap om immunsystemet, genetikk og celler økt enormt. Dette har blant annet gjort at vi idag vet mye mer om leddgikt enn bare for noen år tilbake. Men selv om vi vet i ganske stor detalj hvordan sykdommen utvikler seg, vet vi svært lite om hvordan og hvorfor den begynner. Det foregår store forskningsprosjekter for å få enda bedre forståelse av leddgikt, noe som forhåpentligvis vil kunne gi bedre medisiner og kanskje hindre sykdommen fullstendig.

Annonse

Immunforsvaret

Leddgikt er åpenbart nært knyttet opp mot immunforsvaret. Tilstanden regnes som en autoimmun sykdom. Mye forskning drives derfor mot å forstå bedre hvilken rolle immunforsvaret spiller i sykdommen, og hvilke stoffer som er involvert. Mer kunnskap om dette vil kanskje kunne gi nye metoder for å angripe sykdommen ved hjelp av medisiner som er mer effektive og har færre bivirkninger.

Genetikk

Forskerne antar at om lag halvparten av de personene som får leddgikt, har en genetisk disposisjon. Bedre kunnskap om hvilke gener som forårsaker dette, vil kunne gi viktig informasjon om hvordan sykdommen oppstår, og kanskje muliggjøre effektiv behandling av leddgikt med genterapi.

Infeksjon

Mange forskere mener at det er en infeksjon med virus eller bakterier som utløser leddgiktsykdommen - en autoimmun reaksjon - hos dem som er genetisk disponerte. Det foregår derfor mye forskning for å finne denne organismen. Man kan tenke seg at dersom den blir funnet, vil det kunne være mulig å utvikle en vaksine som hindrer smitte eller helbreder sykdommen.

Hormoner og nervesystemet

Kroppens immunforsvar er nøye forbundet med reguleringen av hormoner og nervesystemet. Det kan virke som om naturlige svingninger i mengden av enkelte hormoner har innflytelse på sykdomsaktiviteten ved leddgikt. Man vet at kvinner har høyere forekomst av leddgikt enn menn, og at de fleste kvinner blir bedre under graviditet. I tillegg har den psykiske helsen stor innflytelse på sykdomsaktiviteten og på hvordan den arter seg. Alt dette tyder på et intrikat samspill mellom ulike "systemer" i kroppen. Bedre forståelse av dette samspillet vil kunne gi ny kunnskap om sykdommen, og kanskje nye angrepsvinklinger for behandling.

Dette dokumentet er basert på det profesjonelle dokumentet Revmatoid artritt . Referanselisten for dette dokumentet vises nedenfor

  1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016 Oct 22;388(10055):2023-2038. Epub 2016 May 3. PMID: 27156434. PubMed
  2. Wasserman A. Rheumatoid Arthritis: Common Questions About Diagnosis and Management. Am Fam Physician. 2018 Apr 1;97(7):455-462. PMID: 29671563. PubMed
  3. Balsa A, Cabezón A, Orozco G, et al. Influence of HLA DRB1 alleles in the susceptibility of rheumatoid arthritis and the regulation of antibodies against citrullinated proteins and rheumatoid factor. Arthritis Res Ther 2010; 12: 62. PubMed
  4. McClure A, Lunt M, Eyre S, et al. Investigating the viability of genetic screening/testing for RA susceptibility using combinations of five confirmed risk loci. Rheumatology (Oxford) 2009; 48: 1369-74. PubMed
  5. Schett G, Firestein GS. Mr Outside and Mr Inside: classic and alternative views on the pathogenesis of rheumatoid arthritis. Ann Rheum Dis 2010; 69: 787-9. PubMed
  6. McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol 2007; 7: 429-42. PubMed
  7. Miossec P, Korn T, Kuchroo VK. Interleukin-17 and type 17 helper T cells. N Engl J Med 2009; 361: 888-98. PubMed
  8. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med 2010; 365: 2205-19. PubMed
  9. Costenbader KH, Feskanich D, Mandl LA, Karlson EW. Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. Am J Med 2006; 119: 503 e1-9.
  10. Bang SY, Lee KH, Cho SK, et al. Smoking increases rheumatoid arthritis susceptibility in individuals carrying the HLA-DRB1 shared epitope, regardless of rheumatoid factor or anti-cyclic citrullinated peptide antibody status. Arthritis Rheum 2010; 62: 369-77. PubMed
  11. Mikuls TR, Payne JB, Reinhardt RA, et al. Antibody responses to Porphyromonas gingivalis (P. gingivalis) in subjects with rheumatoid arthritis and periodontitis. Int Immunopharmacol 2009; 9: 38-42. PubMed
  12. Rantapää-Dahlqvist S, de Jong BA, Berglin E, et al. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum 2003; 48: 2741-9. PubMed
  13. Aletaha D, Neogi T, Silman AJ. 2010 Rheumatoid arthritis classification criteria. An American College of Rehumatology/Europena League Against Rheumatism Collaborative Initiative. Arthritis Rheum 2010; 62: 2569-81. PubMed
  14. Nishimura K, Sugiyama D, Kogata Y et al. Meta-analysis: Diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 2007; 146: 797-808. PubMed
  15. Payet J, Goulvestre C, Biale L, et al. Anticyclic Citrullinated Peptide Antibodies in Rheumatoid and Nonrheumatoid Rheumatic Disorders: Experience with 1162 Patients. J Rheumatol. 2014 Oct 1. pii: jrheum.131375. PMID: 25274898. PubMed
  16. Ford JA, Marshall AA, Liu X, et al. Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to Rheumatoid Arthritis in Clinically Tested Cyclic Citrullinated Peptide Antibody–Positive Patients Without Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2019; 71: 1583-92. pmid:30570827 PubMed
  17. Nielsen SF, Bojesen SE, Schnohr P, Nordestgaard BG. Elevated rheumatoid factor and long term risk of rheumatoid arthritis: a prospective cohort study. BMJ 2012; 345: e5244. doi:10.1136/bmj.e5244 DOI
  18. Ravelli A, Felici E, Magni-Manzoni S, et al. Patients with antinuclear antibody-positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum 2005; 52: 826-32. PubMed
  19. Emanuel G, Charlton J, Ashworth M, et al. Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care . Heart 2016; 102: 1957-62. pmid:27534979 PubMed
  20. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update. Ann Rheum Dis 2020. pmid:31969328 PubMed
  21. Nam JL, Ramiro S, Gaujoux-Viala C, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2014;73:516-28. doi: 10.1136/annrheumdis-2013-204577 DOI
  22. Singh JA, Saag KG, Bridges Jr. SL, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2015; doi: 10.1002/art.39480 DOI
  23. Scott DL, Ibrahim F, Farewell V, et al. Tumour necrosis factor inhibitors versus combination intensive therapy with conventional disease modifying anti-rheumatic drugs in established rheumatoid arthritis: TACIT non-inferiority randomised controlled trial. BMJ 2015; 350: h1046. doi:10.1136/bmj.h1046 DOI
  24. Iannone F, Lopalco G, Cantarini L, et al. Efficacy and safety of combination therapy for preventing bone damage in rheumatoid arthritis. Clin Rheumatol. 2016 Jan;35(1):19-23. Epub 2015 Nov 19. pmid: 26581205 PubMed
  25. Hazlewood GS, Barnabe C, Tomlinson G, et al. Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: abridged Cochrane systematic review and network meta-analysis. BMJ 2016; 353: i1777. doi:10.1136/bmj.i1777 DOI
  26. George MD, Baker JF, Winthrop K, et al. Risk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis : A Cohort Study. Ann Intern Med. 2020. PMID: 32956604 PubMed
  27. Hollan I, Mikkelsen K, Førre Ø. Revmatoid artritt - en risikofaktor for iskemisk hjertesykdom. Tidsskr Nor Lægeforen 2005; 125: 3259-62. PubMed
  28. Durcan L, Wilson F, Cunnane G. The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study. J Rheumatol. 2014 Aug 15. pii: jrheum.131282
  29. Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, et al. Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis. Arthritis Care Res (Hoboken) 2015; 67: 1054-62. doi:10.1002/acr.22561 DOI
  30. Proudman SM, James MJ, Spargo LD, et al. Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis. 2013 Sep 30. PMID: 24081439 PubMed
  31. Tedeschi SK, Bathon JM, Giles JT, et al. Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis. Arhtritis Care Res (Hoboken) 2018; 70: 327-32. pmid:28635117 PubMed
  32. Westhoff G, Rau R, Zink A. Rheumatoid arthritis patients who smoke have a higher need for DMARDs and feel worse, but they do not have more joint damage than non-smokers of the same serological group. Rheumatology 2008; 47: 849-54. Rheumatology
  33. Mattey DL, Brownfield A, Dawes PT. Relationship between pack-year history of smoking and response to tumor necrosis factor antagonists in patients with rheumatoid arthritis. J Rheumatol 2009; 36: 1180-7. PubMed
  34. Gonzalez A, Maradit Kremers H, Crowson CS, et al. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients?. Ann Rheum Dis 2008; 67: 64-9. PubMed
  35. Deighton C, O'Mahony R, Tosh J, et al.; Guideline Development Group. Management of rheumatoid arthritis: summary of NICE guidance. BMJ 2009; 338: b702. BMJ (DOI)
  36. Donahue KE, Gartlehner G, Jonas DE, et al. Systematic review: Comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med 2008; 148: 124-34. Annals of Internal Medicine
  37. O'Dell JR, Mikulus TR, Taylor TH, et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med 2013. doi:10.1056/NEJMoa1303006 DOI
  38. Lopez-Olivo MA, Siddhanamatha HR, Shea B, Tugwell P, Wells GA, Suarez-Almazor ME. Methotrexate for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD000957. DOI: 10.1002/14651858.CD000957.pub2 DOI
  39. Emery P, Breedveld FC, Hall S, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet 2008; 372: 375-82. PubMed
  40. Tilstra JS, Lienesch DW. Rheumatoid Nodules. Dermatol Clin. 2015;33(3):361-71 PubMed
  41. Shea B, Swinden MV, Tanjong Ghogomu E, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000951. DOI: 10.1002/14651858.CD000951.pub2 DOI
  42. Fleischmann R, Kremer J, Cush J, et al. Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. N Engl J Med 2012; 367: 495-507. New England Journal of Medicine
  43. van Vollenhoven RF, Fleischmann R, Cohen S, et al. Tofacitinib or adalimumab versus placebo in rheumatoid arthritis. N Engl J Med 2012; 367: 508-19. New England Journal of Medicine
  44. Burmester GR, Blanco R, Charles-Schumann C, et al. Tofacitinib (CP-690,550) in combination with methotrexate in patients with active rheumatoid arthritis with an inadequate respons to tumour necrosis factor inhibitors: a randomised phase 3 trial. Lancet 2013; 381: 451-60. PubMed
  45. Lee EB, Fleischmann R, GHalls S, et al. Tofacitinib versus methotrexate in rheumatoid arthritis. N Engl J Med 2014 Jun 19; 370:2377. PMID: 24941177 PubMed
  46. Xie F, Yun H, Bernatsky S, Curtis JR. Risk of gastrointestinal perforation among rheumatoid arthritis patients receiving tofacitinib, tocilizumab, or other biologic treatments. Arthritis Rheumatol 2016; 68: 2612. pmid:27213279 PubMed
  47. Statens legemiddelver. Nyheter. Økt risiko for blodpropp i lungene og død ved behandling med høyere dose tofacitinib (Xeljanz). Publisert: 26.03.2019. legemiddelverket.no
  48. Felleskatalogen. Xeljanz. Siden besøkt 01.04.2019. www.felleskatalogen.no
  49. Perrot S, Javier RM, Marty M, Le Jeunne C, Laroche F; CEDR (Cercle d'Etude de la Douleur en Rhumatologie France), French Rheumatological Society, Pain Study Section. Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies. Rheumatology 2008; 47: 1117-23. Rheumatology
  50. Leumbruno JP, Einarson TR, Keystone EC. The safety of anti-tumour necrosis factor treatments in rheumatoid arthritis: meta and exposure-adjusted pooled analyses of serious adverse events. Ann Rheum Dis 2009; 68: 1136-45. PubMed
  51. Singh JA, Cameron C, Noorbaloochi S, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet 2015. doi: 10.1016/S0140-6736(14)61704-9. DOI
  52. Ramiro S, Sepriano A, Chatzidionysiou K, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis 2017. pmid:28298374 PubMed
  53. Berset IP, Klemp M, Jahnsen, et al. Nasjonale faglige retningslinjer for bruk av TNF-α hemmere og andre biologiske betennelsesdempende legemidler innen revmatologi, gastroenterologi og dermatologi. Helsedirektoratet. Revidert utgave februar 2010
  54. Michaud TLRho YHShamliyan TKuntz KMChoi HK. The comparative safety of tumor necrosis factor inhibitors in rheumatoid arthritis: a meta-analysis update of 44 trials. Am J Med. 2014 Dec;127(12):1208-32 . doi:10.1016/j.amjmed.2014.06.012 DOI
  55. Lethaby A, Lopez-Olivo MA, Maxwell LJ, Burls A, Tugwell P, Wells GA. Etanercept for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD004525. DOI: 10.1002/14651858.CD004525.pub2. DOI
  56. Paul Emery, Mohammed Hammoudeh, Oliver FitzGerald, et al. Sustained Remission with Etanercept Tapering in Early Rheumatoid Arthritis. NJEM 2014; 371: 1781-92. doi:10.1056/NEJMoa1316133 DOI
  57. Weinblatt ME, Westhovens R, Mendelsohn AM, et al. Radiographic benefit and maintenance of clinical benefit with intravenous golimumab therapy in patients with active rheumatoid arthritis despite methotrexate therapy: results up to 1 year of the phase 3, randomised, multicentre, double blind, placebo controlled GO-FURTHER trial. Ann Rheum Dis 2013 Sep 3
  58. Smolen JS, Emery P, Fleischmann R, et al. Adjustment of therapy in rheumatoid arthritits on the basis of achievement of stable low disease activity with adalimumab plus methotrexate og methotrexate alone, the randomised controlled OPTIMA trial. Lancet 2013. doi:10.1016/S0140-6736(13)61751-1 DOI
  59. Bijlsma JWJ, Welsing PMJ, Woodworth TG, et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): A multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet 2016 doi: 10.1016/S0140-6736(16)30363-4 DOI
  60. Emery P, Deodhar A, Rigby WF, et al. Efficacy and safety of different doses and retreatment of rituximab: A randomised, placebo-controlled trial in patients who are biological naive with active rheumatoid arthritis and an inadequate response to methotrexate (study evaluating rituximab's efficacy in mtx inadequate responders (serene)). Ann Rheum Dis 2010; 69: 1629-35. PubMed
  61. Lopez-Olivo MA, Amezaga Urruela M, McGahan L, Pollono EN, Suarez-Almazor ME. Rituximab for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD007356. DOI: 10.1002/14651858.CD007356.pub2 DOI
  62. Kirwan JR, Bijlsma JWJ, Boers M, Shea B. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006356. DOI: 10.1002/14651858.CD006356. DOI
  63. Best JH, Kong AM, Lenhart GM, et al. Association between glucocorticoid exposure and healthcare expenditures for potential glucocorticoid-related adverse events in patients with rheumatoid arthritis. J Rheumatol 2018. pmid:29335343 PubMed
  64. Brodin N, Eurenius E, Jensen I, et al. Coaching patients with early rheumatoid arthritis to healthy physical activity. Arthritis Rheum 2008; 59: 325-31. PubMed
  65. Baillet A, Payraud E, Niderprim VA, et al. A dynamic exercise programme to improve patients' disability in rheumatoid arthritis: a prospective randomized controlled trial. Rheumatology (Oxford) 2009; 48: 410-15. PubMed
  66. Jemtland Enger K, Bjørnstad K, Rødevand E, Skomsvoll JF. Effekt av trening på smerte ved revmatoid artritt. Tidsskr Nor Lægeforen 2003; 123: 1508-10. PubMed
  67. Hurkmans E, van der Giesen FJ, Vliet Vlieland TPM, Schoones J, Van den Ende ECHM. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006853. PMID: 19821388 PubMed
  68. Goldbach-Mansky R, Wilson M, Fleischmann R, et al. Comparison of Tripetygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis. A randomized trial. Ann Intern Med 2009; 151: 229-40. Annals of Internal Medicine
  69. Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD002948. DOI: 10.1002/14651858.CD002948.pub2 DOI
  70. Park JK, Lee YJ, Shin K, et al. Impact of temporary methotrexate discontinuation for 2 weeks on immunogenicity of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis 2018. pmid:29572291 PubMed
  71. Chung CP, Sokka T, Arbogast PG, Pincus T. Work disability in early rheumatoid arthritis: higher rates but better clinical status in Finland compared with the US. Ann Rheum Dis. 2006; 65: 1653-7. PubMed
  72. Turesson C, O'Fallon WM, Crowson CS, et al. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 2003; 62:722-7. PubMed
  73. Huang S, Doyle TJ, Hammer MM, et al. Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality. Semin Arthritis Rheum 2020; 50:1216. PMID: 33059295 PubMed
  74. Meune C, Touze E, Trinquart L, et al. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology 2009; 48: 1309-13. Rheumatology
  75. Roubille C, Richer V, Starnino T, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2015; 74: 480-9. doi: 10.1136/annrheumdis-2014-206624 DOI
  76. Lindhardsen J, Ahlehoff O, Gislason GH, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 2011; 70: 929-34. PubMed
  77. Mantel A, Holmqvist M, Andersson DC et al. Association Between Rheumatoid Arthritis and Risk of Ischemic and Nonischemic Heart Failure. J Am Coll Cardiol 2017; 69(10): 1275-85. pmid:28279294 PubMed
  78. Atzeni F, Turiel M, Caporali R, et al. The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Autoimmun Rev 2010; 9: 835-9. PubMed
Annonse
Annonse