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17,18 B cells also play an important part in the pathogenesis of RA through rheumatoid factor and anti-cyclic citrullinated peptide autoantibodies production 19,20 (Figure 1)

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Insulin receptor substrate proteins, chiefly IRS-1, are recruited and phosphorylated, providing binding sites for the regulatory subunit of phosphoinositide 3-kinase and leading through PIP3 and PDK1 to Akt, and onward to mTOR complex 1, GSK-3 and the FoxO transcription factors