JBM  Vol.5 No.9 , September 2017
Five Balances in the Management of Rheumatoid Arthritis
Abstract: Rheumatoid arthritis (RA) is the most common chronic autoimmune joint disease. The etiology of RA is complex, and then it is impossible to cure completely today and it should be individualized treatment. Immune system is complex. Existing statistical techniques based on reductionism cannot discover many relevant disease risk factors and complex interaction relationship. The disease network model based on complex network is important for the analysis and treatment of RA disease. In this Review, we have found five important layers of RA complex network and presented five balances regulating strategy in the management of RA. We have followed up one RA patient (wife of the author) for one year using this strategy, and the management effect is good. This Review argues RA is self-limiting to some extent, and good management with five balances regulating strategy would have positive significance, among which the balance between neuroendocrine system and immune system is the most important. During the day, glucocorticoid plays an important role in con-trolling inflammation, and human growth hormone plays an important role in eliminating inflammation during the slow-wave sleep at night. Five balances core concepts can shed light on the management of other causes of arthritis.
Cite this paper: Zou, S. (2017) Five Balances in the Management of Rheumatoid Arthritis. Journal of Biosciences and Medicines, 5, 10-21. doi: 10.4236/jbm.2017.59002.

[1]   Catrina, A.I., Svensson, C.I., Malmstrom, V., et al. (2017) Mechanisms Leading from Systemic Autoimmunity to Joint-Specific Disease in Rheumatoid Arthritis. Nature Reviews Rheumatology, 13, 79-86.

[2]   Straub, R.H., Bijlsma, J.W.J., Masi, A. and Cutolo, M. (2013) Role of Neuroendocrine and Neuroimmune Mechanisms in Chronic Inflammatory Rheumatic Diseases: The 10 Years Update. Seminars in Arthritis and Rheumatism, 43, 392-404.

[3]   Smolen, J.S., Aletaha, D. and Mcinnes, I.B. (2016) Rheumatoid Arthritis. The Lancet, 388, 2023-2038.

[4]   Singh, J.A., Saag, K.G., Bridges, S.L., et al. (2016) 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research, 68, 1-25.

[5]   Douglas, F. (2017) The Shock Tactics Set to Shake up Immunology. Nature, 545, 20-22.

[6]   Sternberg, E.M. (2001) Neuroendocrine Regulation of Autoimmune/Inflammatory Disease. Journal of Endocrinology, 169, 429-435.

[7]   Kasama, T., Isozaki, T., Takahashi, R. and Miwa, Y. (2016) Clinical Effects of Tocilizumab on Cytokines and Immunological Factors in Patients with Rheumatoid Arthritis. International Immunopharmacology, 35, 301-306.

[8]   Alvarez Nemegyei, J., Buenfil Relloy, F.A. and Pacheco Pantoja, E.L. (2016) Association between Body Composition and Inflammatory Activity in Rheumatoid Arthritis. A Systematic Review. Reumatologia Clinica, 12, 190-195.

[9]   Zampeli, E., Vlachoyiannopoulos, P.G. and Tzioufas, A.G. (2015) Treatment of Rheumatoid Arthritis: Unraveling the Conundrum. Journal of Autoimmunity, 65, 1-18.

[10]   Dixon, W.G. (2015) Rheumatoid Arthritis: Biological Drugs and Risk of Infection. The Lancet, 386, 224-225.

[11]   Mahmood, S., Lesuis, N., Van Tuyl, L.H.D., Van Riel, P. and Landewe, R. (2015) Quality in Rheumatoid Arthritis Care. Best Practice & Research: Clinical Rheumatology, 29, 664-679.

[12]   Lau, C.S., Chia, F., Harrison, A., et al. (2015) APLAR Rheumatoid Arthritis Treatment Recommendations. International Journal of Rheumatic Diseases, 18, 685-713.

[13]   Zuidema, R.M., Repping-Wuts, H., Evers, A.W.M., Van Gaal, B.G.I. and Van Achterberg, T. (2015) What Do We Know about Rheumatoid Arthritis Patients Support Needs for Self-Management? A Scoping Review. International Journal of Nursing Studies, 52, 1617-1624.

[14]   Garner, R., Ding, T. and Deighton, C. (2014) Management of Rheumatoid Arthritis. Medicine, 42, 237-242.

[15]   Gonzalez-Alvaro, I. and Garcia-Vicuna, R. (2016) Rheumatoid Arthritis at Present. Clinical Medicine, 146, 112-114.

[16]   Bearne, L.M., Byrne, A.M., Segrave, H. and White, C.M. (2016) Multidisciplinary Team Care for People with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Rheumatology International, 36, 311-324.

[17]   Barabasi, A.L., Gulbahce, N. and Loscalzo, J. (2011) Network Medicine: A Network-Based Approach to Human Disease. Nature Reviews Genetics, 12, 56-68.

[18]   Ince-Askan, H., Dadboud, J.E.M. and Dolhain (2015) Pregnancy and Rheumatoid Arthritis. Best Practice & Research: Clinical Rheumatology, 29, 580-596.

[19]   Rudman, D., Feller, A.G., Nagraj, H.S., et al. (1990) Effects of Human Growth Hormone in Men over 60 Years Old. The New England Journal of Medicine, 323, 1-6.

[20]   Taylor, P.C. (2014) Aetiopathology of Rheumatoid Arthritis. Medicine, 42, 227-230.

[21]   Opava, C.H. and Bjork, M. (2015) Towards Evidence-Based Hand Exercises in Rheumatoid Arthritis. The Lancet, 385, 396-398.

[22]   Mateen, S., Zafar, A., Moin, S., Khan, A.Q. and Zubair, S. (2016) Understanding the Role of Cytokines in the Pathogenesis of Rheumatoid Arthritis. Clinica Chimica Acta, 455, 161-171.

[23]   Coatesa, L.C., Fitzgeraldb, O., Helliwell, P.S. and Paul, C. (2016) Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis: Is All Inflammation the Same? Seminars in Arthritis and Rheumatism, 46, 291-304.

[24]   De oliveira, S.M., Gomides, A.P.M., Da mota, L.M.H., Luna lima, C.M.B. and Castro rocha, F.A. (2016) Intestinal Parasites Infection: Protective Effect Inrheumatoid Arthritis? Revista Brasileira de Reumatologia, 7.

[25]   Challal, S., Minichiello, E., Boissier, M.C. and Semerano, L. (2016) Cachexia and Adiposity in Rheumatoid Arthritis. Relevance for Disease Management and Clinical Outcomes. Joint Bone Spine, 83, 127-133.

[26]   Bartlett, S.J. (2006) Clinical Care in the Rheumatic Disease. 3th Edition, Atlanta, Ga.

[27]   Verhoeven, F., Tordi, N., Prati, C., Demougeot, C., Mougin, F. and Wendling, D. (2016) Physical Activity in Patients with Rheumatoid Arthritis. Joint Bone Spine, 83, 265-270.

[28]   Withall, J., Haase, A.M., Walsh, N.E., Young, A. and Cramp, F. (2015) Physical Activity Engagement in Early Rheumatoid Arthritis: A Qualitative Study to Inform Intervention Development. Physiotherapy, 102, 264-271.

[29]   Goes, A.C.J., Reis, L.A.B., Silva, M.B.G., Kahlow, B.S. and Skare, T.L. (2016) Rheumatoid Arthritis and Sleep Quality. Revista Brasileira de Reumatologia, 57, 294-298.

[30]   Matcham, F., Ali, S., Hotopf, M. and Chalder, T. (2015) Psychological Correlates of Fatigue in Rheumatoid Arthritis: A Systematic Review. Clinical Psychology Review, 39, 16-29.

[31]   Wan, S.W., He, H.G., Mak, A., et al. (2016) Health-Related Quality of Life and Its Predictors among Patients with Rheumatoid Arthritis. Applied Nursing Research, 30, 176-183.

[32]   Norli, E.S., Brinkmann, G.H., Kvien, T.K., et al. (2016) Self-Limiting Arthritis among Patients Fulfilling the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis in a Very Early Arthritis Cohort. Seminars in Arthritis and Rheumatism, 46, 272-278.

[33]   Veale, D.J. and Fearon, U. (2015) What Makes Psoriatic and Rheumatoid Arthritis So Different? RMD Open, 1, 1-6.

[34]   Zeng, Q.Y., Chen, R., Darmawan, J., et al. (2008) Rheumatic Diseases in China. Arthritis Research & Therapy, 10, R17.

[35]   Barlow, J.D., Yuan, B.J., Schleck, C.D., Harmsen, W.S., Cofield, R.H. and Sperling, J.W. (2014) Shoulder Arthroplasty for Rheumatoid Arthritis: 303 Consecutive Cases with Minimum 5-Year Follow-Up. Journal of Shoulder and Elbow Surgery, 23, 791-799.

[36]   Aletaha, D., Neogi, T., Silman, A.J., et al. (2016) 2010 Rheumatoid Arthritis Classification Criteria: An American College of Rheumatology/European League against Rheumatism Collaborative Initiative. Annals of the Rheumatic Diseases, 69, 1580-1588.

[37]   Taylor, P.C., Moore, A., Vasilescu, R., Alvir, J. and Tarallo, M. (2016) A Structured Literature Review of the Burden of Illness and Unmet Needs in Patients with Rheumatoid Arthritis: A Current Perspective. Rheumatology International, 36, 685-695.

[38]   Jeffery, R.C. (2014) Clinical Features of Rheumatoid Arthritis. Medicine, 42, 231-236.

[39]   Van Beers-Tas, M.H., Turk, S.A. and Van Schaardenburg, D. (2015) How Does Established Rheumatoid Arthritis Develop, and Are There Possibilities for Prevention? Best Practice & Research: Clinical Rheumatology, 29, 527-542.

[40]   Barabasi, A.L. (2007) Network Medicine—From Obesity to the “Diseasome”. The New England Journal of Medicine, 357, 404-407.

[41]   Gu, C.G., Zou, S.R., Xu, X.L., et al. (2011) Onset of Cooperation between Layered Networks. Physical Review E, 84, Article ID: 026101.