Studies of preclinical rheumatoid arthritis synovial histology—a comparison of animal models: comment on the article by de Hair et al

摘要

In a recent prospective study, de Hair et al (1) histo-logically examined synovial biopsy samples from subjects with preclinical rheumatoid arthritis (RA). The biopsies showed normal synovial tissue. No sign of inflammation was detected despite the presence of high levels of anti-citrullinated protein antibodies (ACPAs) and later development of clinical RA. However, subtle infiltration of T cells was observed, and this infiltration was indicative of a weak, although not significant, predictive value for development of RA. Expression of citrul-linated fibrinogen in the preclinical RA biopsy samples did not correlate with future development of RA or with high levels of ACPAs. Some, but not all, ACPA subspecificities were predictive of the development of RA; however, none of these observations led to observable inflammation in the preclinical RA samples. This unique study could be of critical importance to our understanding of how and why inflammation in the joints begins.