Immunological Abnormalities

Activation of inflammatory cells is one of the hallmarks of RA. Proliferation of antigen-presenting cells, B and T lymphocytes is seen in the synovium of patients with RA. Increased T helper and decreased T suppresser and cytotoxic activity are common features of RA [2],

Activation and expansion of CD+ B have been reported in patients with RA and it may be associated with the generation of autoantibodies [74]. Dauphinee et al. [75] found 47% of B cells from patients with RA to express the CD5+ cell surface marker compared to

26% of B cells from normal donors. Continuous stimulation of the CD+ B cells may result in malignant transformation. In humans, malignant transformation of CD5+ cells results in the development of chronic lymphocytic leukemia (CLL) [76]. The risk for the development of CLL among patients with RA was reported to be significantly increased compared to the general population.

In a case report, severe deficiency of T-cell activity was found in patients with RA who developed lymphoma [77]. However, EBV genome was identified in the malignant cells, suggesting that impaired immune activity may increase the risk of viral infections which may trigger malignant transformation.

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