Pathophysiology

The characteristics of a synovium affected by RA are: (a) the presence of a thickened, inflamed membrane lining called pannus; (b) the development of new blood vessels; and (c) an influx of inflammatory cells in the synovial fluid, predominantly T lymphocytes. The pathogenesis of RA is driven by T lymphocytes, but the initial catalyst causing this response is unknown. Understanding specific components of the immune system and their involvement in the pathogenesis of RA will facilitate understanding of current and emerging treatment options for RA. The components of most significance are T lymphocytes, cytokines, and B lymphocytes.4,9

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