Cytokines in rheumatoid arthritis – shaping the immunological landscape
Cytokine-mediated pathways are central to the pathogenesis of rheumatoid arthritis and there has been great advances in understanding and clinical application in the last 20 years. McInnes and colleagues provide a timely and succinct overview the roles of cytokine families in the various phases and tissue compartments of this disease. They particularly review the combinatorial role played by cytokines in mediating the overlapping innate and adaptive immune responses associated with disease onset and persistence.
The success of cytokine inhibition in the clinic has been considerable. The clinical success, besides offering great advances to patients, also helps define the hierarchical position of distinct cytokines in RA pathogenesis, especially IL 6 and TNF. The authors consider how this hierarchy may, in turn, lead to the description of meaningful clinical endotypes and the consequent possibility of future therapeutic stratification.