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T cells in arthritis
  1. ANDREW P COPE
  1. The Kennedy Institute of Rheumatology, Hammersmith, London

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    T cells in arthritis. Edited by P Miossec, W B van den Berg, G S Firestein. (Pp 231; DM 198). Progress in inflammation Research. Series editor M J Parnham. Basel: Birkhauser Verlag, 1998. ISBN 3-7643-5853-X.

    On seeing this title, you might be forgiven for thinking “not another one!” However, this is a T cell book with a difference. Among the contributors, a comprehensive line up of those truly dedicated to their art (with not one Brit among them!), are several senior investigators known to the rheumatology community more for their communications that have underscored the lack of importance of T cells in the pathogenesis of rheumatoid arthritis (RA), than for voicing support for such a role. Accordingly, you are offered a truly balanced view, which is refreshing to say the least. Indeed, the reader should not be put off, under any circumstances, nor surprised by the discovery that the very first chapter is entitled “T cells as secondary players in rheumatoid arthritis” by Firestein and colleagues. An editorial prerogative, perhaps? I was compelled to read the very last chapter of the book first (“T cells as primary players in rheumatoid arthritis”). This was a good decision; Kotzin provides a clear and concise introduction and overview to the field, making the remaining chapters easy reading.

    The book covers topical aspects of T cell biology, of relevance not only to RA, but also to reactive arthritis and juvenile chronic arthritis, with especially useful overviews of T cell receptor rearrangements (Fox and Singer), the balance of Th1/Th2 T cell subsets (Miossec), T cell trafficking to synovial joints (Oppenheimer-Makrs and Lipsky), animal models of arthritis (van den Berg) and T cell directed therapy (Breedveld). The problems associated with defining antigen specificity are underscored, and the reader is left with little alternative but to reflect on how T cells could play important parts in an antigen independent manner, through cognate interactions with macrophages, a concept neatly reviewed in the chapter by Burger and Dayer. These issues are compared and contrasted with the better understood antigenic specificities associated with reactive arthritis and Lyme disease (Sieper and Braun). One aspect overlooked (and this is a minor criticism) could have been remedied by the inclusion of a chapter dedicated to a more detailed discussion of the paradoxical T cell hyporesponsiveness that is so characteristic of chronic inflammatory arthritis. It is this characteristic that has so severely hampered our understanding of how T cells might contribute to the chronic stages of arthritis. The use of new technologies in exploring the field of T cells in arthritis would have been another valuable addition. For example, the use of soluble MHC/peptide complexes as reagents to detect antigen specific T cells in polyclonal populations does not get a mention.

    This work would be good value for any rheumatologist interested in an update on how T cell immunology has progressed in the field of arthritis. Furthermore, I would strongly recommend this book to any student (MD or PhD) about to undertake a research project that in any way encompasses aspects of T cells in the context of inflammatory arthritis.

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