دانلود کتاب Rheumatoid Arthritis Pocket Guide: Full illustrated 2016

IntroductionRheumatoid arthritis (RA) is an inflammatory autoimmune disease that results in significant functional disability due to progressive and widespread joint destruction and soft tissue damage, not only in the limbs but also the inflammatory processes can ultimately have an effect on most organ systems in the body, with devastating morbid consequences. Therefore, appropriate management of RA needs to address not only the impact on joints, but also the whole body, the person suffering from the disease, their families and carers, and where appropriate their employers.Rheumatoid arthritis is associated with substantial economic and healthcare costs,1 RA is presumed to affect between 0.5 and 1% of the population worldwide.2 Two or three times as many women as men suffer from the disease, which can hit at any age, although the peak age of onset in between 30 and 55 years. The major issues in the clinical management of RA have been the absence of a cure, and the inability to halt progression of the disease. The consequences of incomplete control of chronic inflammation in established disease, including pain, disability and co-morbidities (such as cardiovascular disease and osteoporosis) still pose a significant clinical challenge in the management of this disease. Furthermore, its heterogeneity – the disease affects people in different ways, not knowing its causes, identifying the risk factors, and identifying the most appropriate therapy are all issues with the management of RA.However, in the last 10 to 15 years enormous advances in our understanding of the pathogenic processes have led to the development of new targeted therapies, in particular the biological response modifiers or biologics. There are now nine of these products available, and although they are costly, the clinical outcomes continue to look promising. Concurrent with development of these new drugs has come the increased awareness of the disease and improved and earlier diagnosis leading to earlier initiation of therapy soon after the onset of symptoms; this is again leading to improved outcomes.3 This is not to say there is not a role for the traditional treatments - analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids – since there is a use in short-term management of pain and inflammation, and also and conventional/synthetic disease-modifying anti rheumatic drugs (DMARDs), such as methotrexate (MTX), are still the mainstay of treatment for RA especially with the improved treatment regimens. Furthermore, combinations of different DMARDs and in combination with the new biological response modifiers (biological DMARDs or biologics) have been shown to be effective and safe possibly enabling simultaneous effects on different inflammatory pathways involved in the pathogenesis of RA.2 Much of the progress in the development of new therapies was due to discovering new information about the complex interactions between the innate and adaptive immune processes, which have critical roles in the onset and perpetuation of synovitis in RA.4,5 The presence of autoantibodies - rheumatoid factors (RFs) and anti-citrullinated protein antibodies (ACPAs) - in the sera of asymptomatic individuals up to 10 years prior to the appearance of clinical disease and genetic markers that can predict the onset or severity of RA suggests we may be getting closer to the root cause, or at least by identifying the preclinical stage be able to target who and when to treat much earlier.3,6,7In this guide we examine many aspects of RA today and attempt to cover the progress that has been made regarding management, treatment and causes of this debilitating disease.