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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Established rheumatoid arthritis. The pathogenic aspects.

Serena Bugatti1, Emanuele Bozzalla Cassione1, Ludovico De Stefano1

  • 1Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Early Arthritis Clinic, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Italy.

Best Practice & Research. Clinical Rheumatology
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Summary

Rheumatoid arthritis (RA) develops before visible joint inflammation. Understanding changes in the RA synovium may reveal reversible disease stages for earlier treatment opportunities.

Keywords:
FibroblastsLymphocytesMacrophagesRheumatoid arthritisSynovitis

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Area of Science:

  • Immunology
  • Rheumatology
  • Pathology

Background:

  • Rheumatoid arthritis (RA) pathogenesis involves events preceding clinical synovitis.
  • Current RA management often begins after detectable joint inflammation appears.
  • The concept of 'early' versus 'established' RA is dynamic.

Purpose of the Study:

  • To review modifications within the rheumatoid arthritis (RA) synovium.
  • To analyze the roles of immune and stromal cells in RA synovium.
  • To discuss differences between early and established RA synovium.

Main Methods:

  • Literature review of RA synovium research.
  • Analysis of cellular contributions (immune and stromal) to RA pathogenesis.
  • Comparative discussion of early vs. established RA synovium.

Main Results:

  • RA development involves pre-synovitis stages, particularly in autoantibody-positive RA.
  • The synovial membrane is a key site for stage-specific RA drivers.
  • A potential 'window of opportunity' for treatment exists when RA processes are less mature.

Conclusions:

  • Synovial changes in RA are critical and evolve over time.
  • Identifying and targeting early synovial modifications could improve RA treatment outcomes.
  • Further research into RA synovium is essential for understanding disease progression and reversibility.