%0 Journal Article
%T Neutrophils: the forgotten cell in JIA disease pathogenesis
%A James N Jarvis
%A Kaiyu Jiang
%A Howard R Petty
%A Michael Centola
%J Pediatric Rheumatology
%D 2007
%I BioMed Central
%R 10.1186/1546-0096-5-13
%X The nomenclature used to categorize children with chronic arthritis has undergone considerable change over the years covered by this review. The most widely accepted classification scheme replaces the terms juvenile rheumatoid arthritis and juvenile chronic arthritis with the term juvenile idiopathic arthritis. However, it is important for the reader to note that the terms are not synonymous and classification schemes do not completely overlap. This leaves the reviewer with the vexing task of how to refer to earlier studies that used different classification schemes. For the sake of simplicity, clarity, and accuracy, we have elected to use whatever terms were used by the authors of the relevant studies in describing those studies, while adhering to the internationally-accepted classification scheme when speaking generically of chronic arthritis in children.With the possible exception of the systemic-onset form [1], juvenile idiopathic arthritis (JIA) has long been assumed to be an "autoimmune" disease. The autoimmune theory of pathogenesis has tenaciously held its position of unchallenged dogma in pediatric rheumatology, despite serious limits in its ability to explain all the known immunopathological phenomena and the paucity of evidence for either a T- or B-cell driven response (see below). At the same time, no competing theories for pathogenesis have emerged, so the autoimmune theory holds its ground by default. In this review, we will discuss emerging evidence that demonstrates the importance of neutrophils in regulating and informing the adaptive immune response, suggesting, therefore, that innate immunity may play a larger role in JIA pathogenesis than has been previously thought. We will then summarize new data from our laboratories that supports the hypothesis that neutrophil activation in JIA is a primary pathogenic event, and that involvement of the adaptive immune system is downstream of that primary event.This paper is not intended as a comprehensive rev
%U http://www.ped-rheum.com/content/5/1/13