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. 2022 Jan 25;79(2):94. doi: 10.1007/s00018-022-04126-3

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 4 — The proposed role of NETs and increasing ACPAs level in rheumatoid arthritis. (1) ACPAs induce the production and release of inflammatory mediators by macrophages. (2) Inflammatory mediators secreted from macrophages induce NET formation. (3) Citrullinated proteins released during NETosis are recognised by lymphocytes T. (4) Antigen presentation and induction of ACPA production resulting in a vicious inflammatory circle with an excessive immune response