The pathogenesis of rheumatoid arthritis

The New England Journal of Medicine 2011; 365:2205-19

This review article describes the pathogenic processes involved in rheumatoid arthritis (RA) and discusses the genetic factors and environmental triggers implicated in the disease. Data from twin studies are discussed along with candidate genes with single nucleotide polymorphisms (SNPs) that have been linked to RA. It is now thought a multistep progression to the development of RA occurs via environmental factors, epigenetic modification of susceptible genes that leads to altered post-transcriptional regulation, loss of tolerance to self-proteins containing a citrulline residue, and through the action of various triggers that lead to the development of synovitis and structural damage in the joint. The synovial immunological processes and inflammation which develop and lead to structural damage, are discussed along with cytokine response and the systemic consequences of RA.