PDF(Pubmed)
Abstract：
Rheumatoid arthritis (RA) is a chronic autoimmune disorder which can lead to long-term joint damage and significantly reduced quality of life if not promptly diagnosed and adequately treated. Despite significant advances in treatment, about 40% of patients with RA do not respond to individual pharmacological agents and up to 20% do not respond to any of the available medications. To address this large unmet clinical need, several recent studies have focussed on an in-depth histological and molecular characterisation of the synovial tissue to drive the application of precision medicine to RA. Currently, RA patients are clinically divided into \"seropositive\" or \"seronegative\" RA, depending on the presence of routinely checked antibodies. Recent work has suggested that over the last two decades, long-term outcomes have improved significantly in seropositive RA but not in seronegative RA. Here, we present up-to-date differences in epidemiology, clinical features, and serological biomarkers in seronegative versus seropositive RA and discuss how histological and molecular synovial signatures, revealed by recent large synovial biopsy-based clinical trials, may be exploited to refine the classification of RA patients, especially in the seronegative group.
摘要：
类风湿性关节炎（RA）是一种慢性自身免疫性疾病，如果不及时诊断和充分治疗，可导致长期关节损伤并显着降低生活质量。尽管在治疗方面取得了重大进展，约40%的RA患者对个别药物无反应,高达20%的患者对任何可用药物均无反应.为了解决这一巨大的未满足的临床需求，最近的几项研究集中在对滑膜组织进行深入的组织学和分子表征,以推动精准医学在RA中的应用.目前,RA患者在临床上分为“血清阳性”或“血清阴性”RA，取决于常规检查抗体的存在。最近的研究表明，在过去的二十年里，血清阳性RA的长期结局有显著改善,而血清阴性RA则无显著改善.这里,我们提出了流行病学的最新差异，临床特征,和血清阴性与血清阳性RA的血清学生物标志物，并讨论组织学和分子滑膜特征，最近基于滑膜活检的大型临床试验显示，可以用来完善RA患者的分类，尤其是在血清阴性组中。
