Different stages of rheumatoid arthritis: features of the synovium in the preclinical phase

摘要: Background The aetiology of rheumatoid arthritis (RA), a prototype immune-mediated inflammatory disorder, is poorly understood. It currently unknown whether the disease process starts in synovium, primary target RA, or at other sites body. Objective To examine, prospective study, presence synovitis people with an increased risk developing RA. Methods Thirteen without evidence arthritis, who were positive for IgM factor and/or anticitrullinated protein antibodies, included study. evaluate synovial changes, all participants underwent dynamic contrast-enhanced MRI and arthroscopic biopsy sampling knee joint inclusion. Results compared data 6 10 healthy controls, respectively. findings evaluated by measurement maximal enhancement, rate volume enhancement shape curve distribution similar between autoantibody-positive subjects controls. Consistent these findings, but one subject showed very low scores phenotypic markers, adhesion molecules vascularity, same range as those normal person higher had patellofemoral space narrowing. Conclusion Subclinical inflammation synovium does not coincide appearance serum autoantibodies during pre-RA stage. Thus, systemic autoimmunity precedes development synovitis, suggesting that ‘second hit’ involved. This study supports rationale exploring preventive strategies aimed interfering humoral immune response before develops.