Joint destruction in rheumatoid arthritis : Experimental, clinical and epidemiological studies

Sammanfattning: Background. Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic polyarticular synovial inflammation. Erosive joint destruction represents a major unsolved complication of RA. Objectives. The aim of this thesis was to obtain increased knowledge of joint destruction by using a multidisciplinary approach. Firstly, the pathophysiological background of joint destruction was investigated at a cellular level in experimental arthritis. Secondly, consequences of joint destruction on locomotor changes in RA patients and the effect of orthopaedic surgery on RA patients mobility and locomotion were studied. Thirdly, epidemiological studies were performed to elucidate the overall use and application of orthopaedic surgery in Swedish RA patients. Methodology and Results. 1) Collagen-induced arthritis (CIA) is a well-established animal model of arthritis with differential susceptibility in various rat strains. CIA in the arthritis-prone DA rat was used to study potent joint destructive cytokines (RANKL and IL-1