Проблемы иммунопатологии ревматоидного артрита: эволюция болезни
https://doi.org/10.14412/1995-4484-2017-277-294
Аннотация
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, ацетилиро- ванию 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.
Ключевые слова
Об авторе
Е. Л. Насонов
ФГБНУ «Научно- исследовательский институт ревматологии им. В.А. Насоновой», Москва;
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, кафедра ревматологии Института профессионального образования, Москва
Россия
Россия
научный руководитель
заведующий кафедрой ревматологии
академик РАН, профессор, докт. мед. наук
115522 Москва, Каширское шоссе, 34А
119991 Москва, ул. Трубецкая, 8, стр. 2
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Рецензия
Для цитирования:
Насонов Е.Л. Проблемы иммунопатологии ревматоидного артрита: эволюция болезни. Научно-практическая ревматология. 2017;55(3):277-294. https://doi.org/10.14412/1995-4484-2017-277-294
For citation:
Nasonov E.L. PROBLEMS OF RHEUMATOID ARTHRITIS IMMUNOPATHOLOGY: EVOLUTION OF THE DISEASE. Rheumatology Science and Practice. 2017;55(3):277-294. (In Russ.) https://doi.org/10.14412/1995-4484-2017-277-294
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