Tertiary Lymphoid Organs in Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disease. RA mainly affects the joints, with inflammation of the synovial membrane, characterized by hyperplasia, neo-angiogenesis, and immune cell infiltration that drives local inflammation and,
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Introduction.......................................................................................................................... The Synovial Membrane as Site of Inflammation in RA .................................................. 2.1 Histological Patterns of Synovial Inflammation ........................................................ 3 Synovial Tertiary Lymphoid Organs in RA ....................................................................... 3.1 The Development and Regulation of Synovial Tertiary Lymphoid Organs in RA .......................................................................................................................... 3.2 The Function of Tertiary Lymphoid Organs in RA .................................................. 3.3 The Clinical Relevance of Tertiary Lymphoid Organs in RA.................................. 4 Conclusions.......................................................................................................................... Bibliography...............................................................................................................................
Abstract Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disease. RA mainly affects the joints, with inflammation of the synovial membrane, characterized by hyperplasia, neo-angiogenesis, and immune cell infiltration that drives local inflammation and, if untreated, can lead to joint destruction and disability. In parallel to the well-known clinical heterogeneity, the underlying synovitis can also be significantly heterogeneous. In particular, in about 40% of patients with RA, synovitis is characterized by a dense lymphocytic infiltrate that can acquire the features of fully functional tertiary lymphoid organs (TLO). These structures amplify autoimmunity and inflammation locally associated with worse prognosis and potential implications for treatment response. Here, we will review the current knowledge on TLO in RA, with a focus on their pathogenetic and clinical relevance. F. Rivellese E. Pontarini C. Pitzalis (&) Barts and the London School of Medicine & Dentistry, Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, John Vane Science Centre, London, UK e-mail: [email protected] Current Topics in Microbiology and Immunology https://doi.org/10.1007/82_2020_216 © Springer Nature Switzerland AG 2020
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F. Rivellese et al.
1 Introduction Rheumatoid Arthritis (RA) is the most common autoimmune disease, affecting up to 1% of the population worldwide (Smolen et al. 2016). Although RA is well recognized as a systemic disease, its main feature is the chronic inflammation of the synovial membrane, which is characterized by infiltration of immune cells, cellular hyperplasia, and neo-angiogenesis (McInnes and Schett 2011, 2017). Ongoing synovitis and its corresponding clinical features of joint pain and swelling are the main causes of functional disability in patients with RA. Despite the availability of effective medications, in a large proportion o
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