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Other cell types are found within the rheumatoid joint and may
contribute to the pathogenesis. Mast cells may be found in the
rheumatoid synovial membrane and their presence correlates
with clinical activity and cellular infiltration. Mast cells
prominently contribute to the local inflammatory process by
secreting vasoactive materials (histamine, tryptase), cytokines
(TNF , interleukin (IL)-3, IL-4, transforming growth factor (TGF) )
and order chemotactic factors, as well as degradative enzymes.
Mast cells also are capable of inducing platelet aggregation,
endothelial cell activation, and tissue fibrosis. Dendritic cells are
also abundant in the rheumatoid synovium and, like tissue
macrophages, bear an activated phenotype and play an important
role in antigen presentation and cytokine production. Increased
numbers of fibroblasts are also found and are responsible for the
increased synthesis of extracellular matrix components and
degradative products (eg, prostaglandins, cytokines) that
contribute to the joint damage. It has been shown that synovial
fibroblasts have an extended survival and fail to undergo
apoptosis normally.
The articulating surface of the joint is covered with hyaline
cartilage that cushions and protects underlying subchondral bone.
However, the outer margins of the joint are not covered with
articular cartilage, thereby leaving an unprotected or bare area
that lies in proximity to the synovial membrane. This bare area is
often the site of articular erosion in RA. Pannus ( a hyperplastic
form of granulation tissue ) is often found encroaching upon
articular cartilage, tendon sheaths, and the unprotected area of
subchondral bone. This highly vascularized tissue contains a
paucity of lymphocytes and is comprised of numerous cell types,
including transformed mesenchymal cells, synoviocytes,
histiocytes, mast cells, macrophages, and fibroblasts. Pannus is
often found overlying articullar erosions and in some instances,
this junction is relatively acellular. It is thought that pannus
contributes to the generation of bony erosions in RA by locally
perubahan karakteristik patologis yang paling menonjol pada sendi perifer, sendi
khusus diarthrodial. Sebuah sendi diarthrodial dilapisi dengan membran sinovial dan
dilumasi oleh cairan sinovial kental. permukaan tulang yang disandingkan secara
tertutup dengan tulang rawan hialin.
Dengan terjadinya arthritis, biasanya membran sinovial yang tipis (biasanya 1-3 sel
tebal) yang menguraikan rongga sendi mengalami perubahan proliferatif dan
berubah menjadi lapisan yang memperluas sel sinovial (synoviocytes) (gambar 1.1)
membran sinovial terdiri dari tipe A (makrofag - turunan) dan tipe B (fibroblast turunan) synoviocytes, keduanya meningkat jumlahnya karena membran sinovial
menjadi edematous dan diperkaya dengan pembentukan pembuluh darah baru