RESUMO
Rheumatoid arthritis (RA) is an autoimmune/inflammatory disease affecting 0.5 to 1% of adults worldwide and frequently leads to joint destruction and disability. Early diagnosis and early and effective therapy may prevent joint damage and lead to better long-term results. Therefore, reliable biomarkers and outcome measures are needed. Refinement of the understanding of molecular pathways involved in disease pathogenesis have been achieved by combining knowledge on RA-associated genes, environmental factors and the presence of serological elements. The presence of autoantibodies is a distinctive feature of RA. Rheumatoid Factor and Anti-Citrullinated Protein Antibodies are the two most remarkable autoantibodies in RA and provide different clinical and pathophysiological information. They precede the onset of disease symptoms and predict a more severe disease course, indicating a pathogenetic role in RA. Therefore, they promote a more accurate prognosis and contribute for a better disease management. Several RA-associated autoantibody systems have been identified: Anti-Carbamylated Antibodies, Anti-BRAF, Anti-Acetylated, Anti-PAD4 antibodies and others. Hopefully, the characterization of a comprehensive array of novel autoantibody systems in RA will provide unique pathogenic insights of relevance for the development of diagnostic and prognostic approaches compatible with an effective personalized medicine.
Assuntos
Anticorpos Antiproteína Citrulinada/sangue , Artrite Reumatoide/imunologia , Autoanticorpos/sangue , Fator Reumatoide/sangue , Anticorpos Antiproteína Citrulinada/fisiologia , Artralgia/imunologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/genética , Autoanticorpos/fisiologia , Biomarcadores/sangue , Citrulinação/imunologia , Cianatos/metabolismo , Diagnóstico Precoce , Interação Gene-Ambiente , Humanos , Peptídeos Cíclicos/imunologia , Sintomas Prodrômicos , Prognóstico , Carbamilação de Proteínas/imunologia , Proteína-Arginina Desiminase do Tipo 4/imunologia , Proteínas Proto-Oncogênicas B-raf/imunologia , Fator Reumatoide/fisiologia , Sensibilidade e Especificidade , Fumar/sangue , Fumar/imunologia , Fatores de TempoRESUMO
New drugs against advanced melanoma have emerged during last decade. Target therapy and immunotherapy have changed the management of patients with metastatic disease. Along with its generalized use, drug toxicities have appeared and the skin is the target organ of a significant part of them. This revision summarizes the most common side effects and consensus management to improve the compliance of therapies and patients' quality of life. Among the BRAF inhibitors, main cutaneous side effects are photosensitivity, plantar hyperkeratosis, and the appearance of verrucal keratosis or squamous cell carcinoma. Special attention must be paid to the development of new primary melanomas or changes on nevi during BRAF inhibitor therapy. The most common cutaneous side effects of immunotherapy are rash, pruritus, and vitiligo. It remains controversial the possible role of these toxicities as markers of response to therapy.