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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Pathogenesis of rheumatoid arthritis: how early is early? | Available online http arthritis-research.eom contents 7 4 157 Commentary Pathogenesis of rheumatoid arthritis how early is early Gary S Firestein Division of Rheumatology Allergy and Immunology UCSD School of Medicine La Jolla California USA Corresponding author Gary S Firestein gfirestein@ucsd.edu Published 17 June 2005 Arthritis Research Therapy 2005 7 157-159 DOI 10.1186 ar1780 This article is online at http arthritis-research.com content 7 4 157 2005 BioMed Central Ltd See related research by Raza et al. http arthritis-research.com content 7 4 R784 Abstract Studies of cytokine expression in rheumatoid arthritis have provided key insights into the pathogenesis of disease and have offered clues for effective therapy. Patterns of T-cell products in chronic rheumatoid synovitis suggest that T helper type 1 cells contribute to the perpetuation of disease. However there is no guarantee that the mechanisms of late disease are identical to very early rheumatoid arthritis. Evaluation of the cytokine profile at the earliest time points after onset of symptoms could identify novel targets that prevent progression to chronic arthritis. Development of hypotheses to explain the pathogenesis of chronic rheumatoid arthritis RA including the interesting new study by Raza and colleagues 1 has been a wondrous adventure. Virtually every immune cell type and inflammatory mediator has been implicated in the disease process at one time or another. Older temporarily discarded hypotheses on B cells and immune complexes have enjoyed renewed energy with the advent of anti-B-cell therapies 2 . Now that T-cell-directed approaches such as CTLA4-Ig 3 demonstrate efficacy it appears that therapies targeting this cell lineage also are effective in a subpopulation of patients. Hence chronic rheumatoid synovitis is marked by a complex interplay between multiple cell types and individual patients display their own distinct hierarchy for the efficacy of therapeutic interventions 4 . On the other .