Rheumatoid arthritis


  • Recently the Lancet published the results of a study that proposed to repurpose an existing drug to treat rheumatoid arthritis as prophylaxis, to prevent the disease.
  • The results of the study have showed that the rheumatoid arthritis prevention trials are feasible and targeting the adaptive immunity of such individuals at an early stage, can prevent the onset of the rheumatoid arthritis.

What is rheumatoid arthritis?

  • It is a chronic, autoimmune condition which mostly affects the joints.
  • Scientists have not yet completely understood why an autoimmune condition occurs, allowing the immune system that protects the body, to attack itself.
  • A patient experiences pain, swelling of joints and loss of function and mobility as a result of the stiffness.
  • As a result this is likely to significantly lower a patient’s quality of life.
  • It affects the lining of the joints, and also damages the tissue that covers the ends of the bones in a joint.
  • It often occurs in a symmetrical pattern which means that if one knee or hand has the condition, the other hand or knee is also often affected.
  • Fatigue, occasional fevers, and a loss of appetite are to be expected, and there is also a possibility that it may cause medical problems outside of the joints including in the heart, lungs, blood nerves, eyes and skin.

What did the study attempt to do?

  • The idea of the study was to evaluate the feasibility, efficacy, and acceptability of treating high risk individuals with an existing drug, Abatacept, to treat rheumatoid arthritis.
  • The drug is actually a ‘co-stimulation modulator’ which acts as a signalling pathway to start the appropriate immune response.
  • At the core of their experiment is the understanding that individuals at high risk for rheumatoid arthritis can be identified years before they actually develop the disease, even as early as decades earlier.
  • It does so by detecting autoantibodies associated with rheumatoid arthritis known as Anticitrullinated Peptide antibodies (ACPAs), in the blood.
  • Although the presence of autoantibodies might precede disease onset by a decade or more, the combination of ACPA with symptoms, and evidence of subclinical synovitis (inflammation of the lining of the joint) by imaging, has significantly increased the predictive power of identifying individuals who are most likely to progress to rheumatoid arthritis within two years.
  • These features have provided a framework for evaluating therapeutic strategies which could delay or prevent disease onset.
  • The results show that rheumatoid arthritis prevention trials are feasible and targeting adaptive immunity at an early stage, with Abatacept which is an existing drug for RA, before clinically apparent arthritis is manifest, can prevent the onset of rheumatoid arthritis.
  • The drug of choice is Abatacept which is a biological disease-modifying anti-rheumatic drug which works by selectively modulating signals to spur T-cell activation, or begin the body’s immune response.

About T cells:

  • Theyare one of the important types of white blood cells of the immune system and play a central role in the adaptive immune response.
  • They can be distinguished from other lymphocytes by the presence of a T-cell receptor (TCR) on their cell surface.
  • T cells are born from hematopoietic stem cells and are found in the bone marrow.
  • Developing T cells after born migrate to the thymus gland to develop (or mature).
  • They derive their name from the thymus.
  • After migration to the thymus, the precursor cells mature into several different types of T cells.
  • T cell differentiation also continues even after they have left the thymus.
  • Groups of specific and differentiated T cell subtypes have a variety of important functions in controlling and shaping the immune response.
  • One of these functions is immune-mediated cell death.
  • It (immune-mediated cell death) is carried out by two major subtypes: CD8+ “killer” (cytotoxic) and CD4+ “helper” T cells.

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