Autoimmune priming, tissue attack and chronic inflammation—T he three stages of rheumatoid arthritis

R Holmdahl, V Malmström… - European journal of …, 2014 - Wiley Online Library
R Holmdahl, V Malmström, H Burkhardt
European journal of immunology, 2014Wiley Online Library
Extensive genome‐wide association studies have recently shed some light on the causes of
chronic autoimmune diseases and have confirmed a central role of the adaptive immune
system. Moreover, better diagnostics using disease‐associated autoantibodies have been
developed, and treatment has improved through the development of biologicals with precise
molecular targets. Here, we use rheumatoid arthritis (RA) as a prototype for chronic
autoimmune disease to propose that the pathogenesis of autoimmune diseases could be …
Extensive genome‐wide association studies have recently shed some light on the causes of chronic autoimmune diseases and have confirmed a central role of the adaptive immune system. Moreover, better diagnostics using disease‐associated autoantibodies have been developed, and treatment has improved through the development of biologicals with precise molecular targets. Here, we use rheumatoid arthritis (RA) as a prototype for chronic autoimmune disease to propose that the pathogenesis of autoimmune diseases could be divided into three discrete stages. First, yet unknown environmental challenges seem to activate innate immunity thereby providing an adjuvant signal for the induction of adaptive immune responses that lead to the production of autoantibodies and determine the subsequent disease development. Second, a joint‐specific inflammatory reaction occurs. This inflammatory reaction might be clinically diagnosed as the earliest signs of the disease. Third, inflammation is converted to a chronic process leading to tissue destruction and remodeling. In this review, we discuss the stages involved in RA pathogenesis and the experimental approaches, mainly involving animal models that can be used to investigate each disease stage. Although we focus on RA, it is possible that a similar stepwise development of disease also occurs in other chronic autoimmune settings such as multiple sclerosis (MS), type 1 diabetes, and systemic lupus erythematosus.
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