Abstract
Rheumatoid arthritis (RA) — a chronic inflammatory disease affecting synovial tissue in multiple joints — is associated with long-term morbidity and early mortality despite considerable advances in understanding its pathogenesis. Although the identity and role of specific inciting agents is uncertain, immune-mediated mechanisms are likely of crucial importance. The evidence to support a role of CD4+T cells in the immune response in RA patients is substantial, albeit circumstantial [1, 2]. The strongest arguments are: (1) the association of disease susceptibility and outcome with HLA-DR4 antigens and in particular with the “shared epitope” (2) the large number of CD4+T cells that infiltrate the rheumatoid synovium and express activation markers such as HLA-DR; and (3) the modest therapeutic efficacy of interventions directed at T cells. It has become increasingly clear, however, that other cells, in particular activated macrophages and fibroblast-like synoviocytes (FLS) play a critical role in clinical signs of inflammation and in destroying articular structures in chronic disease [3–6]. At present, it is unclear whether sustained T cell activation is required to perpetuate such processes. It is conceivable that after a first phase mediated via T cell dependent pathways, macrophage-and fibroblast-dependent processes become increasingly important as autonomous promoters of synovial inflammation and joint destruction (Fig.1).
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Tak, P.P., Firestein, G.S. (1999). Apoptosis in rheumatoid arthritis. In: Winkler, J.D. (eds) Apoptosis and Inflammation. Progress in Inflammation Research. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8741-0_9
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DOI: https://doi.org/10.1007/978-3-0348-8741-0_9
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