Rheumatoid arthritis: From autoimmunity to synovitis and joint destruction

Rheumatoid arthritis is an autoimmune disease characterized by the production of two known antibodies – rheumatoid factor and anti-citrullinated peptide antibody (ACPA) – against common autoantigens that are widely expressed within and outside the joints. The interactions between genes and environment are crucial in all stages of the disease, involving namely genes from major histocompatibility complex locus, and antigens such as tobacco or microbes (e.g. Porphyromonas gingivalis). T and B cells are activated as soon as the earliest phases of the disease, rheumatoid arthritis appearing as a Th1 and Th17 disease. Inflammatory cytokines have a considerable importance in the hierarchy of the processes involved in RA. The joint destruction seen in RA is caused not only by cytokine imbalances, but also by specific effects of the Wnt system and osteoprotegerin on osteoclasts and by matrix production dysregulation responsible for cartilage damage. Both innate and adaptative immunity demonstrated their respective cornerstone position in rheumatoid arthritis, since targeted treatments has been efficiently developed against TNF-α, IL-6 receptor, IL-1β, CD20 B cells and T-cell/Dendritic cell interactions.

► Autoimmunity in rheumatoid arthritis targets post-translational citrullination.
► Tobacco is a link between environment, genes, and autoimmunity.
► Innate immunity is highly stimulated and appears by itself a target for treatments.
► Tissue destruction is not only the result of chronic inflammation and involves specific mechanisms.