LYCOS RETRIEVER 
Rheumatoid Arthritis: Inflammation
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Cytokines and chemokines play important roles in the progression of rheumatoid arthritis. The development of clinical rheumatoid joint inflammation is associated with increase of the chemokine interleukin-8 (IL-8) in joint tissue. Pro-inflammatory cytokines such as interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are present at high levels in arthritic joints and their blood concentrations increase with the severity of the disease. Monocytes migrate into the joints from the blood and are activated to differentiate into macrophages in the joint tissue by inflammatory cytokines and chemokines such as IL-1, IL-6, IL-8, and TNF-alpha. Activated macrophages play an important role in joint inflammation and destruction. The joint tissue attracts the monocytes into the joints through the production of the chemokines monocyte chemoattractant protein-1 (MCP-1) and IL-8.
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The cutaneous (strictly speaking subcutaneous) feature most characteristic of rheumatoid arthritis is the rheumatoid nodule. The initial pathologic process in nodule formation is unknown but is thought to be related to small-vessel inflammation. The mature lesion is defined by an area of central necrosis surrounded by palisading macrophages and fibroblasts and a cuff of cellular connective tissue and chronic inflammatory cells. The typical rheumatoid nodule may be a few millimetres to a few centimetres in diameter and is usually found over bony prominences, such as the olecranon, the calcaneum at the Achilles tendon insertion, the metacarpophalangeal joints, or other areas that sustain repeated mechanical stress. Nodules are associated with a positive RF titer and severe erosive arthritis. They can rarely occur throughout the body in internal organs.
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The joints most commonly affected by rheumatoid arthritis are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body. Symptoms of rheumatoid arthritis may begin suddenly or gradually. The following are the most common symptoms of rheumatoid arthritis. However each individual may experience symptoms differently. Symptoms may include:
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Rheumatoid arthritis attacks the lining of the joints (synovium). The joints become warm, swollen, tender, and difficult to move. If the inflammation continues, it can destroy cartilage, bone, tendons, and ligaments. The result is permanent joint deformity and disability.
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When rheumatoid arthritis first begins, it is often difficult to diagnosis it clearly. Sometimes it is several months before the blood or x-ray changes occur that enable the doctor to make a diagnosis of rheumatoid arthritis. Diagnosis will be made on an evaluation of the symptoms and tests including a physical examination which will look at each joint for signs of inflammation or other problems. The blood tests and x-rays, as well as helping with the diagnosis... help in monitoring the progress of the disease and the effectiveness of treatment.
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Rheumatoid arthritis (often called RA) is a chronic (long-standing) disease that damages the joints of the body. The damage is caused by inflammation, a normal response by the body’s immune system to “assaults” such as infections, wounds, and foreign objects.
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