Flare Dynamics and Disease Progression in Palindromic Rheumatism

Somashree Chakraborty

PhD Student/IISER Pune (India)

"Flare Dynamics and Disease Progression in Palindromic Rheumatism"

Synovial flares in palindromic rheumatism (PR) are aperiodic inflammatory episodes occurring in the joints, that are thought to follow a relapsing-remitting pattern. The transient and unpredictable nature of such flares is consistent with asymptomatic and non-periodic intervals. We examine the cytokine dynamics in a two-dimensional model of rheumatoid arthritis (RA) and characterise such flares as an excitable trajectory, arising out of stochastic triggers. We address questions pertaining to the frequency, decay, and persistence of synovial flares in individuals with palindromic disease. Our findings demonstrate how adaptive regulations can rescue flares that become “locked” in a 'metastable' state. However, if repetitive locking events occur over a longer timescale, they can activate a secondary adaptation toward a healthy state, which may eventually become maladaptive. Therefore, we argue that the primary mechanism underlying the progression to chronicity lies in the conflict between adaptation and maladaptation, which drives the system toward the fully developed state of rheumatoid arthritis.

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