Challenges in rheumatoid arthritis

Pathogenesis of Rheumatoid disease: 1 Is rheumatic factor relevant? 2 Is apoptosis relevant? 3 Do cytokines have direct involvement in Pathogenesis? 4 Is it a T cell or a B cell disease? 5 Is enzymatic Chondrolysis specific? Disease Progression and Management: 1 Are measures of outcome helpful indicators? 2 The case for early aggressive therapy 3 The case for conservative therapy 4 Does histology or arthroscopy predict outcome? 5 How valuable is imaging? Drug Treatment: 1 Do early systemic steroids prevent disease? 2 Are intra-articular steroids as effective as systemic? 3 Should disease-modifying drugs be used alone or in combination? 4 Does immunotherapy have a role? 5 Is stem cell transplantation ethical and of value? 6 Will there be a role for gene therapy? Benefits and Risks: 1 Do prosthese last longer? Should joints be replaced earlier? 2 Are Occupational therapy and Physiotherapy cost-effective? 3 Is rheumatoid arthritis becoming a milder disease? 4 Should limited funds go to patient care or to research?.