Is RA a single disease? help! | Arthritis Information

 

Hello all,

I am sitting here with many thought running through my brain.  I am "seronegative" RA, only have anemia and elevated ESR show up on my test.  I am still on planquenil, Sulfa, MTX, Arava, prednisone and now Enbrel.  I have read all the info on biologics and the following is about Enbrel.

"Enbrel works by inhibiting the TNF (tumor necrotizing factor) and inducing neutralizing antibodies.  TNF is a proinflammatory cytokine produced by immune system macrophages and T cells, plays a role in initiating the inflammatory process of the immune system.In the healthy immune system, soluble TNF receptors appear to serve as a natural counterbalance to TNF."

I felt the difference in about 2 weeks, even my memory and concentration is better.  They only thing that helped before was prednisone and MTX.  So it makes me thing that I had TNF problems and now I found something that helps.

What I am wondering is if anyone has come across research that indicates that RA is merely a group of signs and symptoms and not a single disease. 

What makes me wonder is the dramatic difference I felt on a biologic, others getting better on AP, others doing fine on DMARDS.

I am thinking "pneumonia", it can be caused by a virus, fungus, bacteria, mechanical means, aspiration and on and on.  Or "hepatitis" that can have so many causes and different treatments.

Any thoughts or ideas?  I teach pathophysiology and have reviewed all the information I have about RA (not much) and haven't learned much.

I think as time goes by we will discover that the disease we currently call RA is actually several different diseases all based on malfunctions in various parts of the immune system.  We all already know there are different triggers.

Even though the disease has been around a long time the technology to truly research it has only been around about 30 years.  As we continue to unlock the genome I believe we will discover the various keys over the next decade

I found this. Although I don't totally understand it, you probably will since you teach pathophysiology.    :)

Hope it helps you.

http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-a rthritis/rheum_clin_path.html

I finally remembered how to make the link!   Thank you for the interesting article.  That is the best scientific explaination I have seen yet.  I have had just enough science to get me into trouble ---now if I could just understand more of what they are talking about.   Thank you grammakathy! bump RA is as you said most likely a combination of multiple hits to different parts of the immune system. I'm not sure exactly what the research shows but it seems like we come in contact with an organism and our body does what it needs to do in order to kill the invader, it turns on the inflammatory process. The problem really seems to lie in when we are exposed to bacteria, viruses, and other organisms that share similar genetic homology as our own then the body can't turn this process off. If we don't kill the bacteria fast enough, then we develop a massive antibody response to it. It's possible that on secondary exposure to the same organism, since the secondary exposure generates a greater response than the first, that our immune system develops antibodies and an inflammatory response that doesn't get shut off because certain parts of our bodies mimic the DNA sequence of the organism and it thinks that the invading organism is always present in high levels. If TNF alpha is the main inflammatory mediator produced then patients respond well to the TNF blockers. If IL 1 is the main inflammatory mediator then patients will respond to IL 1 blockers. If the invading organism is a mycoplasma then it seems like AP protocol works best. The corticosteroids will pretty much work in anyone because they cut off all aspects of the inflammatory process at the nuclear level. An example of sequence homology can be seen with rheumatic fever. Strep A bacteria infects a person and if the infection is not treated quickly enough then the person develops a large amount of antibodies. Through subsequent infections or triggers, the immune system begins to attack the heart valve which shares similar sequence homology to the bacteria and can lead to problems. Perhaps asthma is also similar in that the immune systems develops inflammation in response to chemicals or organisms present in the respiratory airway. Anyways just some ideas relating to this disease. Thanks RX.  I have noticed several post regarding asthma.  I have had it all my life and RA for only 2 years.  But others seem to develop after RA. HMMM.  Interesting. Another strange idea on this disease that I recall reading is that people who have hay fever almost never develop RA. I wonder what the connection is here. It seems like multiple triggers cause the immune system to go haywire, but only in a specific way. Perhaps in hayfever instead of the body being geared towards producing large amounts of TNF alpha and IL 1 it instead uses a path that produces large amounts of eosinophils, IgE or possibly leukotrienes and therefore a different set of symptoms. Most likely the degree of immune malfunction and the symptoms exhibited depend on what organism the body is reacting to. Just a thought! Rx2Heal39369.8578587963
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