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Rheumatoid Arthritis: Pathogenetic Mechanisms and Consequences in Therapeutics

A. R. Colwell Jr., MD
JAMA. 1972;220(11):1502. doi:10.1001/jama.1972.03200110080036.
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The proceedings of the international symposium held at Basel, Switzerland, in March 1971 offer practicing physicians a modern (albeit still primitive) approach to therapy based on pathogenesis of rheumatoid arthritis. The book is a scholarly collection of more than 80 papers in which 36 European (and six American) authors present results of their immunological, pathological, and clinical experiments, and evaluate many of the current developments in rheumatology research.

The inflammatory process involves an immune complex of rheumatoid factor, globulins, and complement, apparently initiated by bacterial or viral agents. There is synovial capillary damage, lysosomal enzyme release from cellular disruption, accumulation of chemical mediators, cartilage dissolution, and bony destruction. Ultrastructural changes include loss of ground substance and disturbance in collagen fibers, perhaps due to certain enzymes. Immunological reactions involve proliferation of lymphocytes and plasma cells, synthesis of immunoglobulins (antibodies) by the synovial membrane and perhaps disturbance in cellular immunity.

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