T-cell and T-cell receptor abnormalities in the immunopathogenesis of juvenile rheumatoid arthritis.

Several lines of indirect evidence suggest that the pathologic autoimmune responses in juvenile rheumatoid arthritis may be antigen-driven and T cell-mediated. These include (1) activation markers expressed on synovial T cells suggestive of previous activation in vivo; (2) persistent oligoclonally expanded T-cell populations accumulating preferentially in the synovial compartment; (3) some T-cell receptor complementarity-determining region 3 sequence similarities between different clones in an individual patient; and (4) T-cell derived cytokines of predominantly Th1 type. Whether T-cell contribution is limited to only early stages of the disease (as appears to be the case in collagen-induced arthritis) or T cells are required for the perpetuation of the inflammation at later stages as well, still remains to be determined.