Elbow joint
Chondrocytes, like synovial fibroblasts, are activated by IL1 and TNF to secrete proteolytic enzymes. elbow joint Inflamatory arthritis. They may, therefore, contribute to the dissolution of their own cartilage matrix, thus explaining the progressive narrowing of joint spaces seen radiographically in this disease. Finally, the neuropeptide substance P is a potent vasoactive, proinflammatory peptide that is likely to contribute to joint destruction and probably explains the remarkable symmetry of this disease. (top of section) Unanswered questions Two pieces in the middle of the puzzle remain inadequately explained in this theory of self-sustained inflammation, however. elbow joint Rectal pain diagnosis. The first is the macrophage. What is the stimulus for its initial and continued recruitment to the joint? And what causes its initial activation? Immune complex deposition (containing a bacterial or viral antigen or rheumatoid factor) in blood vessel walls may lead to local induction of endothelial and monocyte adhesion molecules which, in turn, allows for migration of monocytes into the synovium. Once in the synovium, initial activation of monocytes/macrophages may be induced by g-IFN secreted by activated CD4+ cells. elbow joint Psoriatic arthritis causes. Chronic maintenance in the activated state, however, is presumably independent of g-IFN, but may be promoted by immune complexes (again containing a bacterial or viral antigen or rheumatoid factor itself). Support for this concept comes from synovial biopsies of RA synovium in which IgG, IgM and C3 can be demonstrated by immuno-fluorescence. GM-CSF, elaborated by the synovial fibroblast, may also feedback to sustain the macrophages in a mature, activated state, as already noted. Second, what factor(s) is responsible for the hypertrophy of the synovial lining? The predominant cells in the lining are macrophages and fibroblasts. Mature macrophages do not undergo mitosis, and few mitotic figures are observed in the fibroblast population either.
Elbow joint
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