Chatzidionisyou Aikaterini, Catrina Anca I
Department of Medicine, Solna, Rheumatology Unit, Karolinska University Hospital and Institutet, Stockholm, Sweden.
Curr Opin Rheumatol. 2016 Jan;28(1):76-82. doi: 10.1097/BOR.0000000000000238.
Recent discoveries implicate the lungs as a possible extra-articular mucosal site for initiating rheumatoid arthritis-associated immunity.
Individuals at risk for developing arthritis and patients with early untreated rheumatoid arthritis show signs of lung involvement on high-resolution computer tomography. Rheumatoid arthritis-associated antibodies are present in patients with respiratory complains such as bronchiectasis and unexplained dyspnea even in the absence of joint disease and might predict future development of rheumatoid arthritis in these patients. Rheumatoid arthritis-associated antibodies are detected in the sputum of individuals at risk for developing rheumatoid arthritis but not yet having disease. Signs of bronchial mucosal inflammation with germinal center formation and local production of antibodies have been described in patients with early untreated rheumatoid arthritis. Shared antigenic targets have been identified and characterized in the lungs and joints of rheumatoid arthritis patients.
Recent findings support an important role for the lung as a mucosal extra-articular place were inflammation induced by external triggers (such as smoking) leads to tolerance break and generation of rheumatoid arthritis-specific immunity already before disease onset with only secondary targeting of the joints.
近期研究发现表明，肺部可能是类风湿关节炎相关免疫反应起始的关节外黏膜部位。
有患关节炎风险的个体以及早期未经治疗的类风湿关节炎患者，在高分辨率计算机断层扫描中显示出肺部受累迹象。即使没有关节疾病，患有支气管扩张和不明原因呼吸困难等呼吸道症状的患者体内也存在类风湿关节炎相关抗体，这些抗体可能预示着这些患者未来会发展为类风湿关节炎。在有患类风湿关节炎风险但尚未发病的个体痰液中检测到类风湿关节炎相关抗体。在早期未经治疗的类风湿关节炎患者中，已观察到支气管黏膜炎症伴有生发中心形成和局部抗体产生的迹象。在类风湿关节炎患者的肺部和关节中已鉴定并表征了共同的抗原靶点。
近期研究结果支持肺部作为黏膜关节外部位的重要作用，外部触发因素（如吸烟）引起的炎症会导致免疫耐受破坏，并在疾病发作前就产生类风湿关节炎特异性免疫反应，随后才继发累及关节。
