title: The pathogenesis of rheumatoid arthritis in radiological studies. Part I: Formation of inflammatory infiltrates within the synovial membrane.
abstract: Rheumatoid arthritis is a chronic inflammatory disease with a multifactorial etiology and varied course, which in the majority of patients leads to partial disability or to permanent handicap. Its characteristic trait is a persistent inflammation of the synovial membrane and the formation of an invasive synovial tissue, called the pannus, which in time leads to destruction of the cartilage, subchondral bone tissue, and the soft tissue of the affected joint(s). The pathogenesis of rheumatoid arthritis is complex and involves cells of both innate and adaptive immunity, a network of various cytokines and an immunoregulatory dysfunction. An important role in the discovery of rheumatoid arthritis pathogenesis was played by magnetic resonance imaging, which showed the disease process to extend beyond the synovium into the bone marrow. Many studies have shown a strict correlation between the vascularity of the synovium (assessed through the power Doppler ultrasound and magnetic resonance examinations), bone marrow edema and the clinical, laboratory and histopathological parameters of rheumatoid arthritis. From the current understanding of rheumatoid arthritis, bone erosions could occur from two directions: from the joint cavity and from the bone marrow. With power Doppler ultrasound, as well as in magnetic resonance imaging, it is possible to visualize the well-vascularized pannus and its destructive effects on joint structures and ligaments. In addition, the magnetic resonance study shows inflammatory and destructive changes within the bone marrow (bone marrow edema, inflammatory cysts, and erosions). Bone marrow edema occurs in 68-75% of patients with early rheumatoid arthritis and is considered to be a predictor of rapid disease progression.
authors.affiliation: Zakład Radiologii, Instytut Reumatologii, Warszawa, Polska ; Zakład Diagnostyki Obrazowej, Warszawski Uniwersytet Medyczny, Polska.
authors.forename: Iwona
authors.initials: I
authors.lastname: Sudoł-Szopińska
authors.affiliation: Zakład Patofizjologii, Immunologii i Anatomii Patologicznej, Instytut Reumatologii, Warszawa, Polska.
authors.forename: Ewa
authors.initials: E
authors.lastname: Kontny
authors.affiliation: Zakład Patofizjologii, Immunologii i Anatomii Patologicznej, Instytut Reumatologii, Warszawa, Polska.
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Maśliński
authors.affiliation: Zakład Patofizjologii, Immunologii i Anatomii Patologicznej, Instytut Reumatologii, Warszawa, Polska ; Zakład Diagnostyki Hematologicznej, Instytut Hematologii i Transfuzjologii, Warszawa, Polska.
authors.forename: Monika
authors.initials: M
authors.lastname: Prochorec-Sobieszek
authors.affiliation: Oddział Wczesnej Diagnostyki, Instytut Reumatologii, Warszawa, Polska.
authors.forename: Brygida
authors.initials: B
authors.lastname: Kwiatkowska
authors.affiliation: Zakład Radiologii, Instytut Reumatologii, Warszawa, Polska.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zaniewicz-Kaniewska
authors.affiliation: Zakład Radiologii, Instytut Reumatologii, Warszawa, Polska.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Warczyńska
keywords: bone marrow edema; magnetic resonance imaging; pathogenesis; radiographs; rheumatoid arthritis; ultrasonography