MAximising Therapeutic Utility in Rheumatoid Arthritis
ACR50 - A measure of disease activity. A 50% improvement in American College of Rheumatology (ACR) criteria is defined as both improvement of 50% in the number of tender and swollen joints, and a 50% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure [most often Health Assessment Questionnaire (HAQ)], visual analog pain scale, and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). ACR20 and ACR70 are also used to measure changes in the level of disease, these are a 20% and 70% improvement respectively, in the values as previously described.
Antibody – a blood protein that forms in response to germs, viruses, or any other substances that the body sees as foreign or dangerous. The role of antibodies is to attack these foreign substances and make them harmless.
Anti-TNF (anti-tumour necrosis factor) – TNF is a chemical made by the immune system. When made in the joints it causes the process of inflammation and joint damage. Treatment with anti-TNFs removes the TNF from the joints.
Biobank- a store of biological samples (usually human) for use in research. Biobanks are an important resource in medical research giving researchers access to data and samples from large numbers of people.
Biologics/Biologic Therapy/Biologic DMARD (bDMARD) – a newer type of treatment for autoimmune diseases. These drugs target specific chemical messengers or cells that activate inflammation in the body.
Biomarkers – these are biologic molecules that are useful in measuring the presence or progression of a disease or the effects of a particular treatment. Anti-CCP is a biomarker.
CDAI - The Clinical Disease Activity Index (CDAI) ranges from 0 (remission) to 76 (very active disease). It combines the number of tender joints, swollen joints, the patients score of the level of their arthritis and the clinician’s assessment of the level of arthritis.
C-reactive protein (CRP) – a protein found in the blood. The level of C-reactive protein in the blood rises in response to inflammation and a blood test for the protein can therefore be used as a measure of inflammation or disease activity.
Cytokine - Cytokines are small proteins released by many different cells in the body, including those of the immune system where they coordinate the body’s response against infection and trigger inflammation.
DAS 28 - a Disease Activity Score used to assess the level of disease activity in people with rheumatoid arthritis and guide treatment decisions. It is calculated through an examination of 28 joints, the patients score of the level of their arthritis, and a blood test (ESR or CRP).
Disease-modifying anti-rheumatoid drugs (DMARDs) – drugs used in rheumatoid arthritis and some other rheumatic diseases to suppress the disease and reduce inflammation. Unlike painkillers and non-steroidal anti-inflammatory drugs (NSAIDs), DMARDs treat the disease itself rather than just reducing the pain and stiffness caused by the disease. Examples of DMARDs are methotrexate, sulfasalazine, infliximab, etanercept and adalimumab.
Erythrocyte sedimentation rate (ESR) – a test that shows the level of inflammation in the body and can help in the diagnosis of rheumatoid arthritis. Blood is separated in a machine with a rapidly rotating container (a centrifuge), then left to stand in a test tube. The ESR test measures the speed at which the red blood cells (erythrocytes) settle.
EULAR- The European League Against Rheumatism (EULAR) is a European non-governmental organization which represents the people with arthritis/rheumatism, health professional and scientific societies of rheumatology of all the European nations
Gene - the gene is the basic physical unit of inheritance. Genes are passed from parents to offspring and contain the information needed to specify traits. Genes are arranged, one after another, on structures called chromosomes. A chromosome contains a single, long DNA molecule, only a portion of which corresponds to a single gene. Humans have approximately 20,000 genes arranged on their chromosomes.
Genetic variation – the genetic code differs between individuals and no two are 100% identical. The most common type of variation is a single nucleotide polymorphism, which is a switch of nucleotides at a point in the genome.
Gene expression - gene expression is the process by which the information encoded in a gene is used to direct the assembly of a protein molecule. The cell reads the sequence of the gene in groups of three bases. Each group of three bases (codon) corresponds to one of 20 different amino acids used to build the protein. Expressed genes include those that are transcribed into mRNA and then translated into protein and those that are transcribed into RNA but not translated into protein (e.g., transfer and ribosomal RNAs).
Inflammation – a normal reaction to injury or infection of living tissues. The flow of blood increases, resulting in heat and redness in the affected tissues, and fluid and cells leak into the tissue, causing swelling.
Joint damage – affects the movement of joints and how well they function. Ultrasound is used at an early stage to detect inflammation which may or may not be visible on clinical examination as well as damage or erosion of the bones.
LEI – The Leeds Enthesitis Index (LEI) assesses the level of enthesitis, inflammation of the entheses, the sites where tendons or ligaments insert into the bone. It occurs in ankylosing spondylitis and psoriatic arthritis.
Magnetic Resonance Imaging (MRI) – a type of scan that uses high-frequency radio waves in a strong magnetic field to build up pictures of the inside of the body. It works by detecting water molecules in the body’s tissue that give out a characteristic signal in the magnetic field. An MRI scan can show up soft-tissue structures as well as bones.
Marker - a marker is a DNA sequence with a known physical location on a chromosome. Markers can help link an inherited disease with the responsible genes. DNA segments close to each other on a chromosome tend to be inherited together. Markers are used to track the inheritance of a nearby gene that has not yet been identified but whose approximate location is known. The marker itself may be a part of a gene or may have no known function.
Molecular Phenotyping - measures the levels of molecules in blood or tissues to characterise individuals. Examples include gene expression (RNA) or proteins which may or may not be present and if present, quantities vary.
Musculoskeletal system – the system of muscles, tendons, ligaments, bones, joints and associated tissues that move the body and maintain its form.
Non-steroidal anti-inflammatory drugs (NSAIDs) – a large family of drugs prescribed for different kinds of arthritis that reduce inflammation and control pain, swelling and stiffness. Common examples include ibuprofen, naproxen and diclofenac.
NRAS- National Rheumatoid Arthritis Society (NRAS) is a charity providing information and support services for those affected by rheumatoid arthritis (RA), their families, friends, carers and health professionals in the UK
PARE - EULAR PARE is the network of national organisations of People with Arthritis/Rheumatism across Europe (PARE), united to ensure the voice of people with rheumatic and musculoskeletal diseases is heard and has influence among decision makers within Europe, and to create powerful alliances that will make a difference to their lives.
PASDAS - Psoriatic Arthritis Disease Activity Score (PASDAS) is a measure of disease activity. It ranges from 0-10 and is a composite score that includes patient and physician global scores of skin and joint disease, swollen and tender joint counts, Leeds enthesitis index, tender dactylitis count (number of inflamed digits), the physical component of the Short Form (SF) 36 Health Survey, and level of C-reactive protein.
PASI - Psoriasis Area and Severity Index `(PASI) score is a tool used to measure the severity and extent of psoriasis of the skin.
Pharmacogenomics - pharmacogenomics is a branch of pharmacology concerned with using DNA and amino acid sequence data to inform drug development and testing. An important application of pharmacogenomics is correlating individual genetic variation with drug responses.
Precision medicine - is a targeted approach to patient care that supports doctors to select treatments that are most likely to help patients based on a molecular understanding of the individual’s disease. It aims to improve on the ‘trial and error’ approach used in many areas of medicine.
Protein - proteins are an important class of molecules found in all living cells. A protein is composed of one or more long chains of amino acids, the sequence of which corresponds to the DNA sequence of the gene that encodes it. Proteins play a variety of roles in the cell, including structural (cytoskeleton), mechanical (muscle), biochemical (enzymes), and cell signalling (hormones). Proteins are also an essential part of diet.
PsA - Psoriatic arthritis (PsA) is an auto-immune disease. Is a type of arthritis that affects some people with the skin condition psoriasis. It causes affected joints to become swollen, stiff, and painful and is a long-term condition that can get progressively worse.
Randomised trial / Randomisation – a method of allocating a patient on a clinical trial to a treatment group. Randomisation means the patient is randomly allocated to a treatment group, usually by a computer (similar to tossing a coin), and it is not decided on by their doctor or the researchers running the trial. Randomisation eliminates the selection bias and balances the groups with respect to many known and unknown factors.
Rheumatoid arthritis (RA) – an autoimmune disease that causes inflammation in the joints and less commonly inflammation in other parts of the body.
Rheumatoid factor (RF) – a blood protein produced by a reaction in the immune system. About 80% of people with rheumatoid arthritis test positive for this protein. However, it is possible to have rheumatoid arthritis or another form of inflammatory arthritis with a negative RF.
Single Nucleotide Polymorphisms (SNP) - single nucleotide polymorphisms (SNPs) are a type of polymorphism involving variation of a single base pair. Scientists are studying how single nucleotide polymorphisms, or SNPs (pronounced "snips"), in the human genome correlate with disease, drug response, and other phenotypes.