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Rheumatoid Arthritis: Evolving Concepts of Pathogenesis and Treatment
- JOHN L. DECKER, M.D.;
- DANIEL G. MALONE, M.D.;
- BOULOS HARAOUI, M.D.;
- SHARON M. WAHL, Ph.D.;
- LESLIE SCHRIEBER, M.D.;
- JOHN H. KLIPPEL, M.D.;
- ALFRED D. STEINBERG, M.D.; and
- RONALD L. WILDER, M.D., Ph.D.
Abstract
Rheumatoid arthritis is a chronic inflammatory synovitis that primarily involves peripheral diarthrodial joints. Immunohistologic analysis of diseased synovium has shown a spectrum of abnormalities that resemble various stages of a cell-mediated, or delayed-type, immune reaction. The infiltrating mononuclear cells produce various factors that modulate adjacent tissues and appear to produce the characteristic destructive features of the disorder. Our understanding of the mechanisms of action of various therapeutic modes also indicates that the disease is primarily mediated by activated mononuclear cells. All effective therapies have been shown to affect either mononuclear cell function or the rates of production or elimination of these cells. The disorder likely represents the pathologic expression of a genetically controlled host immune response to an undefined causative stimulus. The stimulus could be an infectious agent(s), a product(s) derived from an infectious agent(s), a constituent(s) of synovial or connective tissue, or a combination of these.
Article and Author Information
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▸An edited transcription of a Combined Clinical Staff Conference held 13 October 1983 at the Clinical Center, Bethesda, Maryland, sponsored by the National Institutes of Health, U.S. Department of Health and Human Services.
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Authors who wish to cite a section of the conference and specifically indicate its author can use this example for the form of reference:
HARAOUI B. Phenotypic characterization of peripheral blood mononuclear cells, pp 812-3. In: DECKER JL, moderator. Rheumatoid arthritis: evolving concepts of pathogenesis and treatment. Ann Intern Med. 1984;101:810-24.
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▸Requests for reprints should be addressed to Wendy Schubert; Office of Clinical Reports and Inquiries, Clinical Center, National Institutes of Health, Building 10B, Room 5C 305; Bethesda, MD 20205.
