From a neutrophilic synovial tissue infiltrate to a challenging case of rheumatoid arthritis.
The herein report illustrates how a synovial tissue heavily infiltrated by neutrophils in the first weeks of arthritis, can evolve in few months to a synovial infiltration by lymphocytes with a characteristic pattern of rheumatoid arthritis (RA). This observation suggests a critical initial role of neutrophils in RA onset, which is eventually surpassed by the activation of the adaptive immune system. In addition, this patient, despite the absence of rheumatoid factors and anti-cyclic citrullinated peptide antibodies, progressed to a highly destructive and disabling disease, that was only controlled adequately with rituximab, due to the lack of response to methotrexate and serious adverse effects with TNF blockers therapy.
Mourão
Ana Filipa
AF
Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon.
Canhão
Helena
H
Sousa
Elsa
E
Cascão
Rita
R
da Costa
João Borges
JB
de Almeida
Luís Soares
LS
Oliveira
Maria Emília
ME
Gomes
Manuel Marques
MM
Queiroz
Mário Viana
MV
Fonseca
João Eurico
JE
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000209:etiology*; D005260:Female; D006801:Humans; D020556:Neutrophil Infiltration; D013585:Synovitis / Q000150:complications* / Q000473:pathology*