Rheumatoid Arthritis: Recent Research Advances

404 Pages·1992·8.63 MB·English

by  A. J. Silman (auth.)

J. S. Smolen J.R. Kalden
R.N. Maini (Eds.)
Rheumatoid
Arthritis
Recent Research Advances
With 53 Figures and 58 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Professor Dr. Josef S. Smolen
2. Medizinische Abteilung
Zentrum fUr Diagnostik und Therapie
rheumatischer Erkrankungen
Krankenhaus der Stadt Wien-Lainz
und Ludwig Boltzmann Institut
fUr Rheumatologie und Balneologie
WolkersbergenstraBe 1, A-ll30 Wien, Austria
Professor Dr. Joachim R. Kalden
Medizinische Klinik III mit Poliklinik
und Institut fUr Klinische Immunologie
und Rheumatologie
Friedrich-Alexander-U niversitat Erlangen-N urnberg
KrankenhausstraBe 12, W-8520 Erlangen
Federal Republic of Germany
Professor Dr. Ravinder N. Maini
Mathilda and Terence Kennedy Institute
of Rheumatology
6 Bute Gardens, Hammersmith
London W6 7DW, United Kingdom
Library of Congress Cataloging-in-Publication Data
Rheumatoid arthritis: recent research advances / J. S. Smolen, J. R. Kalden, R. N. Maini (eds.).
p. cm. Includes bibliographical references and index.
ISBN-13: 978-3-642-76191-1 e-ISBN-13: 978-3-642-76189-8
DOl: 10.1007/978-3-642-76189-8
I. Rheumatoid arthritis. I. Smolen, Josef S., 1950- . II. Kalden, J. R. (Joachim Robert)
III. Maini, R. N. [DNLM: 1. Arthritis, Rheumatoid. WE 346 R47307] RC933.R4288 1992
616.7'227--dc20 DLC for Library of Congress 91-5068 CIP
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To our families
Preface
Clinical medicine first recognized rheumatoid arthritis (RA) as a
disease entity in the nineteenth century. In the early days the major
development in understanding this disease came at the bedside, in
distinguishing it from rheumatic fever and gout. Later, with the
advances in medicine and the powerful ideas emanating from the fast
growing fields of pathology and microbiology, interest turned to the
description of its morbid anatomy and the quest for an infectious
etiology. The development of immunology and biochemistry made an
impact too, and hypotheses tracing RA to infection, fibrinoid
degeneration of collagen, and eventually autoimmunity had their
proponents by the middle of this century.
RA was meanwhile being split up into further nosological entities
as a result of developments emerging on at least two fronts: first, with
the discovery of IgM rheumatoid factor, seropositive and seronegative
disease were differentiated; second, on clinicopathological grounds,
adherents of rheumatoid spondylitis were conceded the existence of
ankylosing spondylitis, a movement which eventually led to the
concept of spondyloarthropathies. The heterogeneity of RA was
further emphasized more recently with the description of "marker"
autoantibodies and associated with the chronic polyarthritis of
conditions such as systemic lupus erythematosus (SLE), primary
Sjogren's syndrome, overlap, and mixed connective tissue disease,
usefully distinguished from RA.
These introductory comments provide a background to our interest
in promoting this book. Having recognized the influence of scientific
thought and technology on clinical research in arthritis and the central
importance of clinical observation in posing questions and guiding
enquiry, it seemed appropriate to ask whether the time was ripe to
attempt to take stock of progress in the field. Recent information
presented by leading researchers at meetings and in journals convinced
us that this was indeed the case and that there were exciting new
prospects for progress. The generosity of the individuals we ap-
VIII Preface
proached, in agreeing to write for this book, will, we hope, bear
testimony to there being grounds for our optimism.
The book begins with a challenging chapter by an epidemiologist
on the incidence and prevalence of RA. Considerable interest sur
rounds the question whether RA is a new disease and whether, as has
been claimed, it is already beginning to disappear. To a large extent
such issues depend on definitions and ascertainment. However, there
is little doubt now that there are geographic variations in disease
expression. The part that genes play in this process can now be
addressed to a degree, and the two succeeding chapters examine this by
reviewing molecular research and taking a fresh look at RA in the
southeastern region of Europe.
The next section deals with aspects of progress in cellular and
immunological fields which have contributed to our understanding of
the pathogenesis ofRA. The role that cytokines and surface molecules
play in regulating cellular function and interactions has been in the
forefront of progress recently and is covered here. This inevitably leads
to contributions on T and B cells, endothelial cells and dendritic cells,
polymorphs, and finally regulation and expression of MHC class II
antigens and the V genes involved in rheumatoid factors.
In the next section, we have selected contributions that highlight
the possible role of environmental factors - principally infectious
agents - and of autoimmunity in initiating and perpetuating RA. This
includes most current candidates, namely, heat shock proteins,
mycobacterial antigens, collagen, streptococcal antigens, retroviruses,
and Epstein-Barr virus. Autoantibodies observed in RA, including
antiperinuclear factor and antikeratin antibodies, are reevaluated, and
new findings on anti-RA 33 are presented. Discussion of the acute
phase response, amyloid, and markers of cartilage destruction pro
vides necessary vignettes to mark progress in the field.
In the final section, therapeutic initiatives are dealt with in two
chapters. Although modern drugs, monoclonal antibodies, and T
cell vaccination are covered, the information is most likely to prove
to be outdated in the near future as a result of intense activity in this
area.
Progress in research is not an orderly affair, and our initial
approach in getting the contents of this book together was to make a
list of areas that we felt were witnessing advances. It is a sign of the
times that even though we did this relatively recently, it is likely that
other fields will have opened up which are not covered. HowevlH, by
inviting some of the key figures in research we expected to gain from
their perceptions and knowledge and thereby secure maximum
coverage of the cutting edge in research. We trust that the result will
justify oUf hopes and that the contents, individually or as a whole, will
coalesce into a worthwhile statement of the state of the art. Ifit inspires
new ideas or a debate, so much the better. It is quite likely that we have
Preface IX
failed to be comprehensive, but for this we do not apologize, since our
wish was not to publish a reference volume but to put together an
enjoyable and readable book.
Wien, Erlangen, and London, May 1992 1. S. Smolen
1.R. Kalden
R.N. Maini
Contents
Introduction
Is Rheumatoid Arthritis a Disappearing Disease?
A. J. Silman ............................................ 3
Genetics
Genetic Factors in Rheumatoid Arthritis
J. S. S. Lanchbury, L. 1. Sakkas, and G. S. Panayi 17
Rheumatoid Arthritis in Southeastern Europe
H. M. Moutsopoulos and P. G. Vlachoyiannopoulos ............ 29
Pathogenesis
Pathogenesis of Rheumatoid Arthritis:
Cellular and Cytokine Interactions
M. Feldmann, F. M. Brennan, M. Field, and R. N. Maini ......... 41
Role of Cellular Adhesion in Rheumatoid Synovitis
M.Ziff ................................................ 55
Endothelial Cells and Dendritic Cells
in Rheumatoid Inflammation
fJ. Fnrre, K. Waalen, and J. B. Natvig ....................... 71
Cellular and Humoral Immune Response
Against Articular Chondrocytes and Proteoglycans
in Rheumatoid Arthritis
G. R. Burmester, S. Alsalameh, and J. Mollenhauer ............ 91
XII Contents
Role and Regulation of Synovial MHC Class II Antigens
in Rheumatoid Arthritis and Related Diseases
L. Klareskog ........................................... 112
CD5+ B Cells and Double-Negative T Cells
in Rheumatoid Arthritis
C. Plater-Zyberk, R. N. Maini, F. M. Brennan, and M. Feldmann . 122
The Genetics of Rheumatoid Factors (RF):
The V-gene Repertoire of RFs in Rheumatoid Arthritis
as Analyzed by Hybridoma Clones
J. B. Natvig, 1. Randen, K. Thompson, and fl. Ferre ............ 137
Neutrophil Polymorphonuclear Cell Function
in Rheumatoid Arthritis
P. Youinou, A. Lamour, A. Dumay, and P. Le Goff ... .......... 150
Etiologic Factors -
Bacterial Antigens, Autoantigens, Viruses
Heat-Shock Proteins and Mycobacterial Antigens
W. van Eden, C. J. P. Boog, E. J. M. Hogervorst,
M. H. M. Wauben, R. van der Zee, and J. D. A. van Embden 167
Type-II Collagen in the Pathogenesis of Rheumatoid Arthritis
R. Holmdahl ............................................ 180
Streptococcal Cell Wall Antigens and Rheumatoid Arthritis
L. J. Crofford and R. L. Wilder ............................. 202
Caprine Arthritis-Encephalitis
E. Peterhans, B. Pohl, R. Zanoni, and S. Lazary 216
Oncogenes and Retroviruses in Rheumatoid Arthritis
G. Stransky, R. E. Gay, A. Trabandt, W. K. Aicher,
S. R. Barnum, and S. Gay ................................. 231
Are Retroviruses Involved in the Pathogenesis
of Autoimmune Diseases?
E. F. Krapf ............................................. ,244
Epstein-Barr Virus and Rheumatoid Arthritis
M. Lotz and J. Roudier ................................... 257
Antibodies to EBV-Encoded Proteins in Rheumatoid Arthritis
P. J. W. Venables ........................................ 281
Contents XIII
Autoantibodies and Markers of Disease Activity
The Antiperinuclear Factor (APF)
and Antikeratin Antibodies (AKA) in Rheumatoid Arthritis
R. M. Hoet and W. J. van Venrooij .......................... 299
Anti-RA33:
A New Antinuclear Antibody in Rheumatoid Arthritis
W. Hassfeld, G. Steiner, W. Graninger, and 1. S. Smolen 319
Acute-Phase Response and Amyloid
G. Husby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 328
Markers of Cartilage Destruction
F. A. Wollheim and T. Saxne ............................... 348
Therapy
Progress in the Therapy of Rheumatoid Arthritis
J. R. Kalden ............................................ 365
T-Cell Vaccination - A Prosp~ct
F. C. Breedveld and R. R. P. de Vries . . . . . . . . . . . . . . . . . . . . . . . .. 385
Subject Index .......................................... 395