Kelley's Textbook of Rheumatology: Expert Consult Premium by Gary S. Firestein MD, Ralph C. Budd MD, Sherine E Gabriel MD

By Gary S. Firestein MD, Ralph C. Budd MD, Sherine E Gabriel MD MSc, Iain B McInnes PhD FRCP FRSE FMedSci, James R O'Dell MD

Kelleys Textbook of Rheumatology can provide the state of the art clinical and scientific information you must provide your sufferers the simplest prognosis and care. This rheumatology book’s sweeping updates spotlight present advances and breakthroughs that influence your perform. With Kelleys Textbook of Rheumatology, youll be capable of deal with the hardest scientific demanding situations you face.

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Example text

3,4,102,103 The external mesenchymal tissue condenses as a fibrous capsule. The peripheral mesenchyme becomes vascularized and is incorporated as the synovial mesenchyme, which differentiates into a pseudomembrane at about the same time as cavitation begins in the central interzone (stage 23, approximately 8 weeks). The menisci arise from eccentric portions of the articular interzone. In common usage, the term synovium refers to the true synovial lining and the subjacent vascular and areolar tissue, up to—but excluding—the capsule.

161,162 In a noninflamed joint, most sensory nerve fibers do not respond to movement within the normal range; these are referred to as silent nociceptors. In an acutely inflamed joint, however, these nerve fibers become sensitized by mediators, such as bradykinin, neurokinin 1, and prostaglandins (peripheral sensitization), such that normal movements induce pain. Pain sensation is upregulated or downregulated further in the central nervous system, at the level of the spinal cord, and in the brain by central sensitization and gating of nociceptive input.

135 These enzymes may be important in limiting the diffusion of these potent peptide mediators away from the immediate vicinity of their site of release and action. 105,136-138 They are essential for cellular attachment to specific matrix components in the synovial lining region, preventing loss into the synovial cavity of cells subjected to deformation and shear stresses during joint movement. Adhesion molecules such as VCAM-1 and ICAM-1 potentially are involved in the recruitment of inflammatory cells during the evolution of arthritis.

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