title: The immunopathogenesis of seropositive rheumatoid arthritis: from triggering to targeting.
abstract: Patients with rheumatoid arthritis can be divided into two major subsets characterized by the presence versus absence of antibodies to citrullinated protein antigens (ACPAs) and of rheumatoid factor (RF). The antibody-positive subset of disease, also known as seropositive rheumatoid arthritis, constitutes approximately two-thirds of all cases of rheumatoid arthritis and generally has a more severe disease course. ACPAs and RF are often present in the blood long before any signs of joint inflammation, which suggests that the triggering of autoimmunity may occur at sites other than the joints (for example, in the lung). This Review summarizes recent progress in our understanding of this gradual disease development in seropositive patients. We also emphasize the implications of this new understanding for the development of preventive and therapeutic strategies. Similar temporal and spatial separation of immune triggering and clinical manifestations, with novel opportunities for early intervention, may also occur in other immune-mediated diseases.
authors.affiliation: Rheumatology Unit, Department of Medicine at Solna, Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden.
authors.forename: Vivianne
authors.initials: V
authors.lastname: Malmström
authors.affiliation: Rheumatology Unit, Department of Medicine at Solna, Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden.
authors.forename: Anca I
authors.initials: AI
authors.lastname: Catrina
authors.affiliation: Rheumatology Unit, Department of Medicine at Solna, Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Klareskog
mesh_terms: D001172:Arthritis, Rheumatoid / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001324:Autoantigens / Q000276:immunology; D006801:Humans
chemical_list: D001323:Autoantibodies; D001324:Autoantigens