T cell, monocyte
Adhesion molecule expression on blood vessels, nitric oxide, prostaglandins, m eta I lo proteinases
CSF, M-CSF, called the autocrine loop). TNF-a and IL-1 are potent upregulators of several cell types including fibroblasts and T cells. TNF-a may act earlier in the hierarchy than other cytokines and has proven to be an important target for anticytokine therapy in rheumatoid arthritis and Crohn's disease (see later, anti-TNF therapy). Some small amounts of anti-inflammatory cytokines may also be present (such as IL-10 and interferon-y), but because the system is not in balance, the end result is inflammation.
The most common types of arthritis in the UK are osteoarthritis (UK prevalence 23%) and rheumatoid arthritis (1%). The less common types of inflammatory arthritis include: juvenile idiopathic arthritis; spondylarthritis (ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disease) and reactive arthritis associated with infection. Joint pains (arthralgia) are common in many other diseases, for example the connective tissue diseases (systemic lupus erythematosus, scleroderma), endocrine conditions (hypo-and hyperthyroidism) and malignancies, but in these, joint inflammation and damage do not usually occur.
The crystal associated conditions, gout and pseudo-gout, are considered later in this chapter.
Drugs have an important place in the therapy of all forms of arthritis, to alleviate symptoms, to modifying the course of the disease and, in the case of septic arthritis, to cure. There follows an account of these drugs.
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