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Key Points A fundamental abnormality in rheumatoid arthritis (RA) is the inappropriate growth of immune cells and stromal cells, imposing high metabolic demands to generate energy and biosynthetic precursors In RA, immune cells and stromal cells undergo metabolic adaptations to generate biomass The disease process in RA involves several stages and multiple tissue sites (such as lymphoid organs and joints), each with a distinct metabolic environment A metabolic signature associated with RA involves the dampening of glycolytic flux and the shunting of glucose into the pentose phosphate pathway in CD4 + T cells In the rheumatoid joint, metabolic intermediates function as signalling molecules and facilitate cell–cell communication, amplifying inflammatory tissue damage The dependence of the rheumatoid disease process on metabolic activity identifies metabolic interference as a potential therapeutic strategy Abstract One of the fundamental traits of immune cells in rheumatoid arthritis (RA) is their ability to proliferate, a property shared with the joint-resident cells that form the synovial pannus

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SanyalAJChalasaniNKowdleyKVMcCulloughADiehlAMBassNMet alPioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis