In 2010, a new drug was released and marketed as a significant breakthrough for people suffering from Rheumatoid Arthritis (RA). That drug was Actemra. It was marketed as an alternative to the existing RA drugs but contained far fewer warnings concerning adverse side effects. In the summer of 2017, a major study was released that questioned the validity of the manufacturer's claims concerning Actemra’s safety and identifies patients that may be at risk of harm from the drug. So what happened? Let’s start at the beginning.
What Is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is a chronic progressive autoimmune disease that causes inflammation in the joints and results in painful deformations and immobility. Most commonly, rheumatoid arthritis affects joints on both sides of the body symmetrically, setting it apart from other types of arthritis. Examples of this would be seen in both wrists, both ankles, both knees, both hands, etc. Less commonly, It can also affect the skin, eyes, lungs, heart and blood.
Rheumatoid arthritis occurs when the immune system produces antibodies that attach to the lining of the joints. The immune system defense cells then attack the joints, causing chronic inflammation, swelling, and pain. When left untreated, rheumatoid arthritis can gradually cause permanent joint damage.
Anyone can develop rheumatoid arthritis and the effects can vary for everyone. Symptoms can develop gradually over years for some, or, very quickly in others. Some sufferers can have active symptoms of the disease for a short time and then go into remission, meaning they will not suffer from active symptoms but still have the disease.
The exact trigger or cause of Rheumatoid Arthritis is unknown. Most doctors have general knowledge concerning the behavior of the immune system once the unknown trigger has entered the body and the attack on the joints (or sometimes other organs) has begun. Some experts believe that a virus or bacteria may change the immune system, causing the attack to occur. Other theories suggest smoking or even certain genetic patterns may make some people more susceptible to Rheumatoid Arthritis than others.
How Does a Healthy Immune System Normally Work?
Normally, a pathogen (bacteria, fungi, or virus) enters the body and the body’s cell process begins by sending defense cells with special receptors that quickly get to work analyzing whether they are dealing with a known pathogen or a foreign pathogen. This pathogen is handled within the two main parts of the immune system, the innate or the adaptive immune systems, which determine which kind of antibodies should be used to fight the pathogen. The innate immune system is the older part of the immune system that sends out scavenger cells to kill most bacterial infections. The adaptive immune system does just as described in its name, it adapts or learns to defend against specific pathogens and can fight bacterial infections or viruses that change over time. These two immune systems are not independent of each other and usually work together in reaction to any pathogen or harmful threat to the body.
In an otherwise healthy person, the body’s immune system can determine the difference between “self-made” and “non-self made” cells by using naturally occurring biological cell processes to differentiate between protein based foreign pathogens (like those on the surfaces of bacteria, fungi, and viruses) and the bodies own surface proteins. The immune system learns to identify the body’s surface proteins early in life as specific “self” cell proteins and usually does not attack these cells. Because the immune system learns the difference between “self” and “non-self” cells, it should not work against its own healthy cells but should fight off infections or complications from “non-self” cells.
How Does the Failure of the Normal Immune System (Autoimmune Disease) Work With Regard to Rheumatoid Arthritis?
In short, when the immune system fails it mistakenly attacks its own healthy cells. With regard to RA specifically, the immune system attacks its own healthy cells that are naturally found in the lining of the joint tissue or are created by joint fluids. The immune system no longer distinguishes the difference between “self-made” cells and “non-self made” cells and attacks both as it would any with other pathogen or harmful threat that enters the body. This mistake causes the immune system cells to create inflammation and painful swelling in the lining of the joint where the miscommunication is occurring, which can eventually wear down cartilage. As cartilage wears down, space between the bones is lost and bones could eventually rub together. If left unidentified and/or untreated, this can eventually result in bone erosion and joint deformity.
Treating Rheumatoid Arthritis
There are many different medications and treatment options for Rheumatoid Arthritis. Your Rheumatologist is the best person to determine which treatment plan may be best for you. In our next article, we explore some of the most common methods of treating RA. Click the button below to learn more about RA Treatment.