Pathogenesis and mechanisms of inflammation in the childhood rheumatic diseases
Pathogenesis and mechanisms of inflammation in the childhood rheumatic diseases
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DOI：
10.1097/00002281-199809000-00011
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发表时间：
1998-09-01
影响因子：
5.1
通讯作者：
Jarvis, James N.
中科院分区：
文献类型：
--
作者：
Jarvis, James N.
幼年类风湿性关节炎患儿滑膜中存在CD 4+细胞，这导致了一种普遍接受的假设，即获得性免疫的异常激活或调节是这一疾病家族发病机制的核心;然而，这一假设仍然没有得到证实，而且，事实上，对于成人或儿童，T细胞在类风湿性疾病的慢性滑膜炎过程中的特定作用还有待确定。与此相反，先天免疫相关的过程必然涉及类风湿性关节炎和幼年型类风湿性关节炎的慢性滑膜炎的病理生理学。中性粒细胞在滑液中的存在、补体激活以及免疫复合物在滑液和血清中的积聚都表明了活跃的炎症过程。因此，有理由假设，从对炎症或先天免疫的更仔细研究中可以收集到幼年型类风湿性关节炎病因的重要线索。本文将重点介绍补体、免疫复合物和血管内皮在幼年类风湿性关节炎发病机制中的作用。在这样做的时候，它将重新审视T细胞在幼年类风湿性关节炎疾病发病机制中的中心作用的教条，并提供新的范式来理解这种和其他儿童风湿性疾病。
The presence of CD4+ cells in the synovium of children with juvenile rheumatoid arthritis has led to the generally accepted hypothesis that aberrant activation or regulation of acquired immunity is central to the pathogenesis of this family of diseases; however, this hypothesis remains unproven, and, indeed, a specific role for T cells in the process of chronic synovitis in rheumatoid disease has yet to be identified for either adults or children. In contrast, processes associated with innate immunity are undeniably involved in the pathophysiology of chronic synovitis in both rheumatoid arthritis and juvenile rheumatoid arthritis. The presence of neutrophils in the synovial fluid, complement activation, and immune complex accumulation in the synovial fluid and serum all indicate an active inflammatory process. It is reasonable to hypothesize, therefore, that there are important clues to the cause of juvenile rheumatoid arthritis to be gleaned from a more careful study of inflammation or innate immunity. This review will focus on the roles of complement, immune complexes, and the vascular endothelium in the pathogenesis of juvenile rheumatoid arthritis. In so doing, it will reexamine the dogma of the central role of the T cell in juvenile rheumatoid arthritis disease pathogenesis and offer new paradigms with which to understand this and other rheumatic diseases of childhood.