Cytokine production in the rheumatoid joint: implications for treatment

Article Abstract:

Rheumatoid arthritis (RA) is the commonest disease that has symptoms of inflammation and autoimmune dysfunction, in which the immune system makes antibodies against an individual's own tissues. A genetic predisposition to RA has been found, but this does not entirely explain the disease. A normal joint is virtually sealed off from blood-derived cells, while rheumatoid joints have all types of cells, especially lymphocytes (white blood cells important in fighting infections). Many of the lymphocytes are activated, which means they may produce cytokines (proteins which carry ''signals'' between lymphocytes mediating inflammatory and other reactions). Analysis of cytokines in rheumatoid joints could increase information about how RA develops, and might provide targets for drug treatment. The development of a protocol by which cytokines can be studied is described. Recent advances in measurement techniques for individual proteins like the cytokines have aided this work. The relative abundance of 19 cytokines and their RNA (the genetic material used in the synthesis of proteins) in joint fluid and joint cells was measured. Previous studies had shown that interleukin-1 (IL-1) may be of primary importance in development of joint disease, and thus the regulation of IL-1 by other cytokines was investigated. Preliminary results indicated that tumor necrosis factor (TNF) increased production of IL-1, and blockade by antibodies prevented IL-1 production. Thus, TNF may be a promising target of drug therapy. However, cytokines are very localized messenger molecules, and more studies using localization techniques are being done. Regulation of cytokines by other messenger molecules must also be investigated. These studies are promising, and much more can be done to further the understanding of the processes that underlie rheumatoid arthritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Drug therapy, Cytokines

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Correlation of histopathological features of pannus with patterns of damage in different joints in rheumatoid arthritis

Article Abstract:

Pannus is an inflammatory exudate (material-containing fluid which accumulates or penetrates through a tissue region) which overlies the synovial lining (lubricating tissue) of a joint. The function and origin of pannus in rheumatoid arthritis are unclear, and descriptions of the junction between pannus and joint cartilage vary. Some have suggested that the junction may occur as one of two basic patterns of structure. In one, a transitional zone of fibroblasts (cells which give rise to connective tissue) overlies the cartilage surface and causes an indistinct region between pannus and cartilage. In joints in which this transitional zone is absent, the junction is well defined and cells associated with classic invasive pannus are present. The prevalence and distribution of these two types of junctions were studied in 23 knee, hip, finger, and arm joints. The distinct junction pattern was twice as common in finger joints as in hip or knee joints, while the transitional zone was found predominantly in the large weight-bearing joints (hips and knees). Both junction types were present within eight joints and were found to merge with each other. Cartilage degradation was greater in areas with invasive cell-distinct junctions. The results suggest that invasive pannus with a distinct junction is related to the predominance of erosive changes in small joints. Pannus with an indistinct junction may be a tissue reaction resulting from demands such as weight-bearing and may be associated with joint space narrowing and subsequent osteoarthritis in the large weight-bearing joints. The study suggests that it is inappropriate to compare disease-associated changes in different types of joints. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Arthritis associated with adjuvant mycobacterial treatment for carcinoma of the bladder

Article Abstract:

A patient developed arthritis and inflammation in many joints of the body following administration of harmless Calmette-Guerin bacteria to treat bladder cancer. Inflammation of the membranes enclosing the affected joints was found that contained a certain type of disease-fighting white blood cell, the T cell. The inflammation of the joint membranes disappeared without treatment within two weeks.

Care and treatment, Causes of, Complications and side effects, Arthritis, Bladder cancer, BCG vaccines, BCG

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