Проблемы иммунопатологии ревматоидного артрита: эволюция болезни

Автор: Насонов Е.Л.

Журнал: Научно-практическая ревматология @journal-rsp

Рубрика: Прогресс в ревматологии в XXI веке

Статья в выпуске: 3 т.55, 2017 года.

Бесплатный доступ

В обзоре рассмотрены новые данные, касающиеся иммунопатологии ревматоидного артрита (РА), с акцентом на раннюю стадию заболевания. Эволюция РА включает несколько последовательно (или дискретно) развивающихся стадий, завершающихся развитием симптомокомплекса, характерного для РА. Однако характер взаимодействия факторов внешней среды, генетической предрасположенности и иммунных механизмов, определяющих переход от стадии к стадии, варианты прогрессирования, характер и выраженность внесуставных (системных) проявлений и риск коморбидных заболеваний, до конца не ясен и в настоящее время является предметом интенсивных исследований. Среди патогенетических механизмов развития РА важное место занимает гиперпродукция аутоантител - ревматоидные факторы (РФ) и антитела к белкам, подвергнутым посттрансляционной модификации (ПТМ) - цитруллинированию, карбамилированию, ацетилированию и т. д. Развитие иммунного ответа против посттрансляционно модифицированных (в первую очередь цитруллинированных) белков является ключевым патогенетическим механизмом развития РА на всех стадиях заболевания. Новые данные, касающиеся роли АЦБ в развитии боли и костной резорбции в отсутствие воспаления, патогенетически обосновывают существование «преклинической» фазы заболевания, характеризующейся артралгиями и гиперпродукцией аутоантител. В заключение рассматриваются новые возможности профилактики РА в группах риска (АЦБ-позитивная клинически подозрительная артралгия) с использованием метотрексата, анти-В-клеточного препарата ритуксимаба, блокатора костимуляции Т-лимфоцитов абатацепта и др.

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Болезнь стилла взрослых, генно-инженерные биологические препараты, глюкокортикоиды

Короткий адрес: https://sciup.org/14946007

IDR: 14946007 | DOI: 10.14412/1995-4484-2017-277-294

Список литературы Проблемы иммунопатологии ревматоидного артрита: эволюция болезни

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