You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


Selective Costimulation Modulators: Addressing Unmet Needs in Rheumatoid Arthritis Management: The Immune Complex Theory


The Immune Complex Theory

The conventional view concerning the pathogenic mechanisms of RA has been that autoantibodies -- particularly rheumatoid factor (RF) and anticyclic citrullinated peptide (CCP) antibody -- appear to be of particular importance.[11] Nielen and colleagues[13] examined the relationship between these autoantibodies and the eventual diagnosis of RA symptoms by determining antibody concentrations in serial blood samples obtained for several years before the onset of RA symptoms. The proportion of patients with a positive test result for either antibody increased steadily in the years preceding the onset of symptoms. RF and anti-CCP antibody were not present in every patient, although they were more likely to appear in patients with more severe symptoms. These findings, and others,[14,15] suggest that an unidentified trigger stimulates the production of autoantibodies by B lymphocytes several years before the eventual onset of clinically evident RA. RF (or other autoantibody) immune complex deposition in the joint will eventually lead to joint destruction. Neutrophils and macrophages infiltrating the joint via chemotactic gradients bind to the immune complexes and/or to a fixed complement and are induced to degranulate, releasing destructive enzymes that damage the articular structures.[11]