The Inflammatory Process

The inflammatory process is a byproduct of the body's immune system, which fights infection and heals wounds and injuries. When an injury or an infection occurs, white blood cells are mobilized to rid the body of any foreign proteins, such as a virus. The masses of blood cells that gather at the injured or infected site cause the area to become inflamed. Under normal conditions, the inflammatory process is controlled and self-limited, but in people with chronic rheumatoid arthritis, certain defects, probably genetic, keep this process going.

Genetic Factors

Although much has been learned about the inflammatory process leading to rheumatoid arthritis, researchers have yet to uncover the factors that lead to this devastating self-attack. One prevalent theory is that a combination of factors trigger rheumatoid arthritis, including genetic susceptibility, an abnormal autoimmune response, and a viral infection. 

HLA-DR4. HLA is genetic type that produces molecules that trap antigens, which are then targeted and attacked by the immune system. Researchers have identified a molecule called HLA-DR4, which is present in many patients with autoimmune conditions.

Lack of Corticotropin-Releasing Hormone. Some people may have a genetic deficiency of a hormone, known as corticotropin-releasing hormone (CRH), which produce corticosteroids, other hormones that suppress the inflammatory process.

P53. Even successful treatment of the inflammation does not completely prevent further joint destruction. Research has found the presence of a mutated gene known as p53 in synovial tissue obtained from a group of patients. In such cases, the mutation is not inherited but appears to develop as part of the disease process. 

Infectious Triggers

Although many bacteria and viruses have been studied, no single organism has been proven to be the primary trigger for the autoimmune response and subsequent damaging inflammation. Higher than average levels of antibodies that react with the common intestinal bacteria E. coli have appeared in the synovial fluid of people with RA, which some experts think may stimulate the immune system to per petuate RA once the disease has been triggered by some other initial infection.