From: David A Gabel, ENN
Published September 8, 2011 09:48 AM

New Study Takes Us One Step Higher in the Cascade of Events which Cause Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder which primarily affects synovial joints. The condition can be painful and disabling, leading to loss of function and mobility if not properly treated. The disease is caused by immune cells acting out of control, attacking the cartilage and bone. A new study from Northwestern University has found what causes this to happen. The immune cells are missing a vital protein, P21, which acts like a bouncer, keeping the immune cells in line. According to Dr. Robert Gabel, practicing rheumatologist of the Central New Jersey area, this discovery may lead to effective methods to treat RA by going farther up the cascade of events causing the disease.


Researchers at the Northwestern University Feinberg School of Medicine have managed to isolate a single essential protein for the prevention of rheumatoid arthritis. The immune cells causing inflammation in test mice with RA were missing this protein, known as P21. After developing and injecting an imitation of the protein, the researchers observed a halt in the disease process.

"The 'bouncer' molecule stopped the immune cells from going crazy," said lead author Harris Perlman, associate professor of rheumatology at Northwestern's Feinberg School. "Imagine destructive customers in a bar, and the bouncer says, 'You are going to behave!' That's P21. This discovery opens up a new avenue for future therapies, which are greatly needed for rheumatoid arthritis."

Experienced rheumatologists, such as Dr. Robert Gabel, are well aware of existing treatments for RA, and know that none of them are the magic bullet which RA patients seek. However, he believes that this breakthrough could potentially lead to very effective preventative methods by addressing the disease farther up the cascade of events.

One existing treatment is the use of anti-inflammatory medicines such as ibuprofen and prednisone which is very good at suppressing rheumatic disorders. However, these medicines only treat the symptoms and not the cause of RA. Going farther up the cascade of events, there are preventative treatments which include various cancer meds. In the old days, gold injections were used.

Newer treatments which go farther up the cascade are known as biological treatments. "These treatments stop the substances that induce other cells to make inflammations, such as TNF," stated Dr. Gabel, who has operated a rheumatology clinic for over 30 years. TNF, or tumor necrosis factor, is an endogenous substance within the immune cells involved in systematic inflammation. "TNF blockers prevent inflammation from starting."

TNF is therefore a harmful substance if left unchecked. According to the Northwestern University study, for healthy individuals, the presence of the protein P21 keeps substances like TNF in check, preventing rheumatoid arthritis from occurring. Without it, the immune cell goes berserk and attacks not just foreign bacteria and viruses, but the body's own bones and cartilage.

Like many diseases, one event causes another, which causes another, and so on until symptoms become apparent and the unhealthy condition establishes itself. This is what the cascade of events refers to. The identification of P21 may be the farthest researchers have ever gone up the cascade of events for rheumatoid arthritis. The next step may be to ask why the immune cells are missing the P21 protein in the first place? For now, there is more work to be done to turn the information from this discovery into a practical application.

The new study has been published in the journal, Arthritis & Rheumatism.

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