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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting mainly the synovial joints. Processes involved in the initiation of inflammation in RA are largely unknown. Recent work has shown that systemic autoimmunity precedes synovial inflammation in autoantibody positive individuals developing RA1 and animal models have suggested that lymph node changes may precede inflammation in the synovial tissue.2 Ultrasound guided lymph node biopsy under local anaesthesia has previously been used as a diagnostic tool in haematology and oncology.3 Therefore, we started to use this technique to provide insight into the pathogenic processes involved in the earliest phases of RA, by analysing lymph node tissue obtained during different phases of the disease. Our experience includes use of this technique in autoantibody positive individuals without arthritis who are at risk of developing RA,4 early arthritis patients and established RA …
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