Novel autoantibodies in rheumatoid arthritis.

Rheumatoid factor and antibodies against cyclic citrullinated peptides represent a diagnostic hallmark in rheumatoid arthritis (RA). However, over the last decades many other autoantibodies have been identified. Several proteins can trigger an aberrant autoimmune response in their native form while others acquire this feature after post-translational modifications such as citrullination, carbamylation or acetylation. It is of interest that also the enzymes catalyzing such post-translational modifications (e.g. the protein arginine deiminases) can transform themselves into autoantibodies in RA. The purpose of this review article is to provide an overview of relevant literature published over the last years regarding novel autoantibodies and their possible diagnostic and prognostic significance in RA.

Extra-articular rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease that mainly affects the joints, though a consistent proportion of patients may also display extra articular manifestations (EAMs). From rheumatoid nodules to interstitial lung disease, from cardiovascular events to vasculitis, the spectrum of EAMs encompasses various conditions with different prognoses. EAMs may also occur as first RA manifestation, therefore the coordination with other health professionals, including general practitioners, is needed. The aim of this article is to provide an overview on EAMs in RA with particular focus on the recognised risk factors and the available recommendations for managing them, as well as comorbidities in RA patients.

A strategy for health manpower development.

PIP: The Institute of Health Sciences was established on the island of Leyte in the Philippines in 1976 for the specific purpose of training health personnel for work in the depressed and underserviced areas on the islands of Leyte and Samar. The Institute differs markedly from other medical institutions in terms of recruitment policies, training procedures, and goals. The key elements in the program include 1) the recruitment of students from the depressed areas ultimately to be served by the program; 2) a ladder type of training program which permits students to pogress through various levels of medical service certification from health worker to physician; and 3) the punctuation of academic training with periods of in-service work back in the student's community of origin. The Institute is designed to offer 5 progressive levels of training including 1) a health worker program; 2) a community health worker program; 3) a nursing program; 4) a bachelor of science program in community medicine; and 5) a doctor of medicine program. The 5th level of training has not been fully implemented as yet. The students at the Institute are recent high school graduates who have been nominated by their local communities to participate in the program. All the students begin the program at the 1st level and progress up the ladder as far as possible taking into account individual trainee desires and aptitudes, community needs, and evaluation by Institute personnel. Participants in the program are not legally bound to work in their communities of origin after the completion of their training. It is expected that most of these individuals will elect to return to the depressed areas because 1) the trainees grew up in low income, rural families unlike their counterparts at other institutions; 2) the trainee's ties with his village of origin are constantly reinforced by the in-service training built into the program; 3) the students are accorded high prestige in their communities; and 4) the Institute instills in the students a sense of social responsibility.^ieng