Treatment of Arthralgia Syndrome with Acupuncture and Chinese Medicine in China

Over the last several decades, research has greatly increased our understanding of immunology, genetics, and cellular and molecular biology. This foundation in basic science is now showing results in several areas important to rheumatoid arthritis. Scientists are thinking about rheumatoid arthritis in exciting ways that were not possible even 10 years ago.

The National Institutes of Health funds a wide variety of medical research at its headquarters in Bethesda, Maryland, and at universities and medical centers across the United States. One of the NIH institutes, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, is a major supporter of research and research training in rheumatoid arthritis through grants to individual scientists, Specialized Centers of Research, and Multipurpose Arthritis and Musculoskeletal Diseases Centers.

Following are examples of current research directions in rheumatoid arthritis supported by the Federal Government through the NIAMS and other parts of the NIH.

Scientists are looking at basic abnormalities in the immune systems of people with rheumatoid arthritis and in some animal models of the disease to understand why and how the disease develops. Findings from these studies may lead to precise, targeted therapies that could stop the inflammatory process in its earliest stages. They may even lead to a vaccine that could prevent rheumatoid arthritis.

Researchers are studying genetic factors that predispose some people to developing rheumatoid arthritis, as well as factors connected with disease severity. Findings from these studies should increase our understanding of the disease and will help develop new therapies as well as guide treatment decisions. In a major effort aimed at identifying genes involved in rheumatoid arthritis, the NIH and the Arthritis Foundation have joined together to support the North American Rheumatoid Arthritis Consortium. This group of 12 research centers around the United States is collecting medical information and genetic material from 1,000 families in which two or more siblings have rheumatoid arthritis. It will serve as a national resource for genetic studies of this disease.

Scientists are also gaining insights into the genetic basis of rheumatoid arthritis by studying rats with autoimmune inflammatory arthritis that resembles human disease. NIAMS researchers have identified several genetic regions that affect arthritis susceptibility and severity in these animal models of the disease, and found some striking similarities between rats and humans. Identifying disease genes in rats should provide important new information that may yield clues to the causes of rheumatoid arthritis in humans.

Scientists are studying the complex relationships among the hormonal, nervous, and immune systems in rheumatoid arthritis. For example, they are exploring whether and how the normal changes in the levels of steroid hormones (such as estrogen and testosterone) during a person's lifetime may be related to the development, improvement, or flares of the disease. Scientists are also looking at how these systems interact with environmental and genetic factors. Results from these studies may suggest new treatment strategies.

Researchers are exploring why so many more women than men develop rheumatoid arthritis.In hopes of finding clues, they are studying female and male hormones and other elements that differ between women and men, such as possible differences in their immune responses.To find clues to new treatments, researchers are examining why rheumatoid arthritis often improves during pregnancy. Results of one study suggest that the explanation may be related to differences in certain special proteins between a mother and her unborn child. These proteins help the immune system distinguish between the body's own cells and foreign cells. Such differences, the scientists speculate, may change the activity of the mother's immune system during pregnancy.

A growing body of evidence indicates that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people who have an inherited predisposition to the disease. Investigators are trying to discover which infectious agents may be responsible. More broadly, they are also working to understand the basic mechanisms by which these agents might trigger the development of rheumatoid arthritis. Identifying the agents and understanding how they work could lead to new therapies.

Scientists are searching for new drugs or combinations of drugs that can reduce inflammation, can slow or stop the progression of rheumatoid arthritis, and also have few side effects. Studies in humans have shown that a number of compounds have such potential. For example, some studies are breaking new ground in the area of "biopharmaceuticals," or "biologics." These new drugs are based on compounds occurring naturally in the body, and are designed to target specific aspects of the inflammatory process.

Investigators have also shown that treatment of rheumatoid arthritis with minocycline, a drug in the tetracycline family, has a modest benefit. The effects of a related tetracycline called doxycycline are under investigation. Other studies have shown that the omega-3 fatty acids in certain fish or plant seed oils also may reduce rheumatoid arthritis inflammation. However, many people are not able to tolerate the large amounts of oil necessary for any benefit.

Investigators are examining many issues related to quality of life for rheumatoid arthritis patients and quality, cost, and effectiveness of health care services for these patients. Scientists have found that even a small improvement in a patient's sense of physical and mental well-being can have an impact on his or her quality of life and use of health care services. Results from studies like these will help health care providers design integrated treatment strategies that cover all of a patient's needs-emotional as well as physical.

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