Clinical paradigms and pathogenetic explanations.

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Presentation transcript:

Clinical paradigms and pathogenetic explanations. Clinical paradigms and pathogenetic explanations. The well-established clinical sequence of disease activity and structural damage is in the centre of the figure. At the same time, in clinical studies, rheumatoid factor (RF) has been shown to be linked to damage of rheumatoid arthritis via increasing disease activity, but also directly (blue arrows). Antibodies against citrullinated peptides/proteins (ACPA) is also associated with structural outcomes (solid green arrow). However, ACPA have not been shown to be associated with clinical disease activity. Vice versa, disease activity might even be lower in ACPA-positive patients (broken green arrow; see also, section ‘ACPA paradox’). Since this finding needs further confirmation, it is marked with a ‘?’. The panels around the central sequence are pathogenetic explanations for these clinical links; these links are quite well established for RF and the inflammatory disease processes (A), RF and direct effects on progression (B), as well as ACPA and its direct links to progression (D). They are hypothetical for the (paradoxic) link between APCA and disease activity (C). For details on the links and references see respective sections in the text. Daniel Aletaha, and Stephan Blüml RMD Open 2016;2:e000009 Copyright © BMJ Publishing Group & EULAR. All rights reserved.