A Review of the Histopathological Evidence on the Pathogenesis of Cartilage Destruction in Rheumatoid Arthritis

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Abstract
According to Zvaifler, the pathologic. sequence of events occurring in the rheumatoid joints may be divided into three stages (1). In the first, unknown antigen, reaching into the synovial membrane through systemic circulation, initiates the immune response. In the second, a chronic inflammation takes place involving complex interactions between various immuno-competent cells which have migrated into the joint space. In the third, destruction of bone and cartilage takes place, finally leading to irreversible joint damage and deformities. In this article, we discuss how cartilage is destroyed in the rheumatoid joint. Damage could theoretically be produced by 1) enzymatic digestion from the articular surface of cartilage; 2) destruction by the invading pannus; or 3) a primary disease process in chondrocytes themselves. Previous studies indicate that all these processes can occur in the rheumatoid joints. However, the important question relates to the relative significance of each of these factors in contributing to the pathogenesis of joint damage. Here we discuss the histopathological evidences by reviewing literatures in the hope to clarify what is known and what remains to be solved in future.