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Abstract Rheumatoid arthritis is a generalized disorder which predominantly affects synovial joints. The synovial membrane displays a chronic non suppurative inflammation which is associated with erosive destruction of joint cartilage, ligaments, tendons and subchondral bone tManicourt et al., 1(93). Juvenile rheumatoid arthritis differs in many respects from adult rheumatoid arthritis. Oligoarthritis is common and systemic onset is seen more frequently. Large joints are more predominantly involved than small joints. Subcutaneous nodules and RF seropositivity are unusual, but ANA seropositivity is a hallmark of this disease (( ’assidy, 19(3). Cytokines are thought to play an important role in RA disease process. TNF produced mainly by macrophages and monocytes and has been found in high concentrations in RA synovial membrane (Firestein et al., 1(88). It has been implicated in the pathogenesis of RA as it may be involved not only in regulation of immune response in rheumatoid synovitis but also in cartilage and bone destruction (Feldmann et al., 1(91). In addition, it has other effects on many cells, causing cell proliferation, increased prostaglandin and matrix metalloprotease activity, inhibition of proteoglycan synthesis by 1 chondrocytes as well as fever and other systemic manifestations (Buchan et al .. 1(88). |