Is angiogenesis a cause or consequence in Rheumatiod Arthritis???

Rheumatoid Arthritis (RA) affects nearly 1% of the world’s population, onset is most frequent between the ages of 40-50, but people of any age can be affected, women are 3X more likely to be infected. RA can be a disabling and painful condition, which can lead to loss of function and mobility if not properly treated. RAis a chronic, systemic inflammatory disorder that can affect many tissues and organs but primarily targets the synovial joints. Patients present with pain and stiffness in one to multiple joints with symptoms appearing over weeks to months usually starting in one joint and progressing to multiple joints. Other symptoms associated with RA include but are not limited to weakness, fatigue, anorexia and depression. The disease course in RA can range from a short period and only affect a single joint and little joint damage to the extreme progression of affecting multiple joints and extreme joint damage resulting in the degradation of bone and cartilage.

The review article I discussed in class talks about angiogenesis and whether or not it was a cause of consequence associated with RA. Angiogenesis occurs as the expansion of the synovial lining of joints in rheumatoid arthritis (RA) requires an increase in the vascular supply to the synovium ,in a response with the increased need for oxygen and nutrients. New blood vessel formation – ‘angiogenesis’ – is recognized as a key event in the formation and maintenance of the pannus in RA. Many pro-angiogenic factors are expressed in the RA synovium like vascular endothelial growth factor, VEGF, which is a signal protein that stimulates the growth of new blood vessels. It is part of the system that restores the oxygen supply to tissues when blood circulation is insufficient. Anti-angiogenic models have been unable to provide a direct answer to this question. Knowing this information what do you think does angiogenesis and factors like VEGF drives RA or whether synovial proliferation promotes it?