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Question: How does RA affect the synovium?


The synovium is a primary target for the inflammatory process in RA. Both layers are radically affected quite early (perhaps within weeks) in the course of the disease. Type A synoviocytes thicken the synovial lining probably by local proliferation. The subsynovium also thickens by infiltration of lymphocytes and macrophages. Although B cells are present, the majority of infiltrating cells are T lymphocytes with a phenotype characteristic of memory T cells. Suppressor T cells are notably scarce. Multinucleate giant cells and hemosiderin-laden macrophages are also seen. Angiogenesis is a prominent and early change as well. Later, fibronectin is deposited on articular cartilage. In contrast to the synovial tissue, synovial fluid has a predominance of polymorphonuclear leukocytes, and of the T cells present in the fluid, most are CD8+.

Reference: Harris ED, Budd RC, Firestein GS, et al (eds): Kelley’s Textbook of Rheumatology, 7th ed. Philadelphia, W.B. Saunders, 2005

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