艾拉莫德对临床前类风湿关节炎的潜在治疗价值

The potential therapeutic value of iguratiomd in preclinical rheumatoid arthritis

类风湿关节炎(rheumatoid arthritis,RA)是一种以四肢小关节慢性炎性病变为主要表现的全身性自身免疫病,可引起关节畸形以及其他重要脏器并发症,严重影响患者的生存质量。RA尚不能治愈,即使完全缓解也难以恢复到疾病前免疫状态,停药容易复发。RA在确诊前存在长时间免疫异常演变过程,以自身抗体和其他生物标志物异常为特征,被称为临床前类风湿关节炎(Pre-RA)。在Pre-RA阶段进行有效干预,恢复自身免疫异常,也许能够达到治愈可能,但目前缺乏有效治疗方案。证据显示传统改善病情药甲氨蝶呤不能阻断RA发生,而B细胞抑制剂利妥昔单抗可以延缓RA诊断,提示B细胞异常在Pre-RA演变过程中可能起重要作用。在RA改善病情药物中,艾拉莫德抑制B细胞的作用比较突出,对Pre-RA可能具有潜在的治疗价值,本文综述了Pre-RA的疾病特点以及艾拉莫德可能的作用机制。

Rheumatoid arthritis(RA)is a systemic autoimmune disease characterized by chronic inflammatory changes in small joints of the extremities,which can develop to joint deformity and merge to serious complications of other important organs,greatly reducing the life quality of patients.So far,RA cannot be cured,even if it is completely relieved.It is difficult to recover to the immune state of predisease,and it is easy to relapse after drug withdrawal.RA is characterized by abnormal autoantibodies and other biomarkers,and is known as preclinical rheumatoid arthritis(Pre-RA).Effective intervention in the Pre-RA stage for autoimmune abnormality recovery may be able to achieve the possibility of cure;however,there is no effective treatment plan at present.Evidence shows that the traditional disease-improving drug methotrexate cannot block the occurrence of RA,while the B cell inhibitor rituximab can delay the diagnosis of RA,suggesting that the abnormal function of B cells may play an important role in the evolution of Pre-RA.Among RA disease-improving drugs,iguratimod plays a prominent role in inhibiting B cells,which may have potential therapeutic value for Pre-RA.Therefore,this article summarizes the disease characteristics of Pre-RA and the possible mechanisms of action of iguratimod.