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pathology of rheumatoid arthritis

Pathology: 1) cellular & humoral immune mechanisms 2) destructive inflammatory response involving synovium a) joint destruction, little reparative tissue b) chronic exudative inflammation of synovium with - hypertrophy & hyperplasia of synovial lining cells - focal fibrinous exudation, - infiltration by lymphocytes & plasma cells - lymphoid follicles not uncommon c) inflamed synovium -> pannus over articular surface destroying underlying cartilage d) cadherin-11 on the surface of synovial cells triggers inflammation & synovial proliferation [2] 3) secondary damage a) adjacent cartilage & bone - cartilage degradation causes joint space narrowing [3] b) ligaments & tendons 4) joint erosions occur within the 1st 2 years of disease 5) vasculitis mediated by immune complex deposition - small-vessel vasculitis usually involves the skin - skin biopsy shows leuckocytoclastic vasculitis [4] - large-vessel vasculitis can mimic polyarteritis nodosa 6) stimulation of osteoclast activity by osteoprotegerin ligand has been suggested [1] 7) increased risk of cardiovascular disease thought to be inflammatory-induced 8) iron-binding acute phase protein detected with variable frequency in serum of patients with rheumatoid arthritis (non-specific) 9) proteins in synovial fluid in patients with RA - TNFAIP6 10) autoantibodies in patients with RA a) rheumatoid factor* b) cyclic citrullinated peptide antibody* c) antinuclear antibodies (ANA) - generally diffuse immunofluorescence pattern d) anti keratin antibodies (AKA) e) anti perinuclear factor f) anti RA33 g) anti RA-associated nuclear antigen (RANA) h) anti synovial stimulatory protein p205 i) anti gp130 (non-specific) j) anti MMP19 k) anti ANXA11 l) anti GRP78 (HSPA5) * rheumatoid factor & cyclic citrullinated peptide antibody are associated with an increased risk of rheumatoid arthritis but neither are necessary nor sufficient to cause the disease [3]

Related

rheumatoid arthritis (RA)

General

rheumatology

References

  1. Journal Watch vol 19, #24, pg 192-93 Dec 15, 1999 Kong YY et al, Nature 402:304, 1999
  2. Lee DM, Kiener HP, Agarwal SK, Noss EH, Watts GF, Chisaka O, Takeichi M, Brenner MB. Cadherin-11 in synovial lining formation and pathology in arthritis. Science. 2007 Feb 16;315(5814):1006-10. Epub 2007 Jan 25. PMID: 17255475 - Firestein GS. Biomedicine. Every joint has a silver lining. Science. 2007 Feb 16;315(5814):952-3. No abstract available. PMID: 17303744
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  4. Seetharaman M (slide show with images) Rheumatoid Arthritis: In and Out of the Joint. Medscape. March 22, 2016 http://reference.medscape.com/features/slideshow/rheumatoid-arthritis