Medical and Patient Self Management Programs in Rheumatoid Arthritis

**107**

**Chapter 6**

**Abstract**

ways of various cytokine receptors.

**1. Introduction**

Diagnostic Challenges and

*Mihail Virgil Boldeanu, Adrian Răzvan Ionescu,* 

*Valeriu Horațiu Popoviciu, Andreea Lili Bărbulescu,* 

*Rodica Pădureanu, Andreea Meca, Vlad Pădureanu,* 

*Mircea Cătălin Forțofoiu, Ioan Sabin Poenariu,* 

*Lidia Boldeanu and Ananu Florentin Vreju*

*Ștefan Cristian Dinescu, Isabela Siloși, Maria Forțofoiu,* 

Rheumatoid arthritis is a chronic, systemic inflammatory disease, with certain evidence of multiple factors involved, but also with the strong autoimmune component, leading to a high potential for disability, through synovial inflammation and joint destruction. Diagnostic methods and management possibilities have recently improved, thus leading to a better outcome, based on the treat to target recommendation. Although biologic agents represent efficient therapeutic agents, in the last few years, the advances in understanding the mediators involved in rheumatoid arthritis pathogenesis have provided new targeted therapies, represented by small molecule inhibitors against the Janus kinases that contribute in the signaling path-

**Keywords:** rheumatoid arthritis, autoimmune disease, biologic agents, new therapies

Rheumatoid arthritis (RA) is a chronic, autoimmune, systemic disease that targets primarily the synovial joint lining and causes progressive disability. Untreated, PR leads to the destruction of the joints by the erosion of cartilage and bone material. Loss of physical function is the aftermath, which is why early treatment is vital

Angiogenesis is an important process for the growth and development of all tissues, during which new blood vessels are formed from pre-existing vascularization and play a critical role in the pathogenesis of several inflammatory autoimmune diseases, such as PR. Angiogenesis is triggered by the dominance of pro-angiogenic factors over endogenous angiostatic mediators. Studies conducted over the past two decades have suggested the involvement of numerous proangiogenic factors such as metabolites, ions, growth factors, hypoxia-inducible

for controlling disease activity and for preventing joint damage.

Management Update in

Rheumatoid Arthritis

### **Chapter 6**
