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The two articles on adipose tissue and its pro-inflammatory role in rheumatoid arthritis (RA) and osteoarthritis (OA) by prof. Sudol-Szopinska et al.(1, 2) offer an interesting insight view on the patho-mechanics of such diseases.  It is particularly involving the concept of the adipose tissue as an endocrine organ. Moreover, keeping in mind embryology, it is intriguing to recall the common genesis this tissue has with the cellular lines responsible for fibrous tissue formation and osteo-chondral evolution in such environments.  The articles clearly describe the persisting inter-relation maintained between neighbouring tissues originated by the same progenitor cellular lines. As a consequence, imaging diagnostics get a new interest in documenting the activation, or the persistence, of the inflammatory process and they can contribute to the regulation of therapeutic strategies in rheumatic diseases at the stage of initial diagnosis and follow-up.  Some speculative considerations can be added in order to find out which kind of consequences such findings could have on surgery when applied in the treatment of R A or OA cases.  Imaging of the para-articular adipose tissue contributes to the understanding and staging of the aggressiveness of the disease: in such instances the efficacy of a medical treatment can be better monitored in order to confirm its therapeutic effect.  Surgical synovectomy does have a place in association to the pharmacological regime when an anatomical district does not respond in a satisfactory way to drug administration, after a time deemed as appropriate. It can be speculated if a selective ablation of well-defined areas of the articular fat tissue could also be taken into consideration in order to interfere with the pathogenetic mechanisms inducing tendon and joint changes and cartilage wearing.  Of interest is also the observation of the characteristics of nerve fibers, which can be found in the infrapatellar fat pad (IPFP) of RA and OA patients, and their responsibility in pain perception related to substance P production.  Concluding, it is certainly attractive for the surgeon to have an extra monitoring tool that can help in defining indication and timing of a surgical therapeutic option and that can contribute in following up its effectiveness. It remains to be evaluated in which terms such interesting observations on the pro-inflammatory role of adipose tissue could directly influence the planning and carrying out of those surgical procedure that aim to hinder the progression of an articular disease.

journal of ultrasonography

Komentarz redakcyjny do artykułu I. Sudoł-Szopińskiej, E. Kontny, K. Zaniewicz-Kaniewskiej, M. Prohorec-Sobieszek, F. Saieda i W. Maślińskiego pt.: Rola czynników zapalnych i tkanki tłuszczowej w patogenezie reumatoidalnego zapalenia stawów i choroby zwyrodnieniowej stawów. Część I oraz artykułu I. Sudoł-Szopińskiej, P. Hrycaja i M. Prohorec- -Sobieszek pt.: Rola czynników zapalnych i tkanki tłuszczowej w patogenezie reumatoidalnego zapalenia stawów i choroby zwyrodnieniowej stawów. Część II