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Rheumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by inflammation of synovial joints and often leads to progressive joint damage, functional disability and systemic effects in multiple organs. Although a range of therapies is available to treat RA, many patients do not have an adequate response to treatment and few achieve remission. An in-depth understanding of the immunological processes underlying the various aspects of RA could advance the development of novel therapeutics.
In this Focus on the immunology of RA, the four specially commissioned Review articles provide an update on areas of research in RA that have seen notable advances in the past few years, including new insights into the development and persistence of the autoantibody response, the influence of metabolism and its perturbations, the role of synovial tissue macrophages, and the mechanisms of joint destruction.
In this Review, the authors discuss the latest insights into how autoantibodies and autoreactive B cells relate to the disease process in rheumatoid arthritis, from the development of pre-disease seropositivity to the onset of overt symptoms and the maintenance of disease chronicity.
In this Review, the authors discuss the characterization of distinct synovial tissue macrophage (STM) populations and their functions in the context of the healthy and arthritic joint. They also describe how distinct STMs are specified, how they respond to danger signals and the clinical implications of understanding STM heterogeneity.
In this Review, the authors discuss how the inflammatory, hypoxic environment of joints in rheumatoid arthritis affects metabolism in fibroblasts, endothelial cells and immune cells. Understanding the competing requirements of these cells can enable effective therapeutic targeting of synovial metabolism.
In this Review, the authors provide an overview of the mechanisms contributing to joint damage in rheumatoid arthritis, particularly the interactions among immune cells, fibroblasts and bone, and discuss how this knowledge could inform the development of novel therapies.