55. Chronic Inflammation

Question 1

How long does acute inflammation take to present?

Answer 1

Days

Question 2

How long is chronic inflammation present for?

Answer 2

Months or years

Question 3

Name the 2 sub-sets of chronic inflammation

Answer 3

1. Non-specific

2. Specific (primary)

Question 4

To which subset of chronic inflammation does granulomatous inflammation derive?

Answer 4

specific chronic inflammation

Question 5

Give a definition of non specific chronic inflammation.

Answer 5

A dynamic balance between tissue destruction and repair.

Question 6

Periodontitis is a form of which type of chronic inflammation?

Answer 6

Periodontitis - non-specific chronic inflammation

Question 7

Name the 4 stages of inflammation and give an example at each stage.

Answer 7

1. Initiation (health)
2. Progression (Mild gingivitis)
3. Amplification (severe gingivitis)
4. Resolution? (If no -> periodontitis)

Question 8

Does specific chronic inflammation arise with or without warning?

Answer 8

Without warning

Question 9

Give the 2 categories specific chronic inflammatory responses can be classed as.

Answer 9

1. Granulomatous

2. Non granulomatous

Question 10

Specific chronic inflammation is characterised by excessively activated __________________.

Answer 10

Macrophages

Question 11

Specific chronic inflammatory responses can be induced by which 2 types of agents? Give examples of each.

Answer 11

1. Non-immunological (foreign body reaction eg. grit in a wound).
2. Immunological (eg. hypersensitivity reaction)

Question 12

Which type of inflammation are autoimmune diseases examples of?

Answer 12

Specific chronic inflammation.

Question 13

Give an example of an autoimmune disease.

Answer 13

Rheumatoid arthritis

Question 14

Describe the process of “loss of tolerance” in autoimmune diseases, with reference to specific amino acids.

Answer 14

Due to infection, enzymes produced convert arginine to citrulline which is not recognised as a self-protein. The body has thus lost tolerance against its “self cells” and attacks the body’s own cells.

Question 15

Describe the type and give the name of the most prominent cells in chronic granulomatous inflammation.

Answer 15

Modified activated macrophages called epithelioid cells.

Question 16

Describe how “giant cells” are formed.

Answer 16

Fused epithelioid macrophages.

Question 17

Name and give examples of the 2 ways chronic granulomatous inflammation can be induced.

Answer 17

!. Non immunological (foreign particles)

2. Immunological (hypersensitivity)

Question 18

Briefly describe the transition from monocytes to macrophages.

Answer 18

Monocytes circulate in the blood, reach the tissue then differentiate into macrophages.

Question 19

Describe the main aim of macrophages.

Answer 19

To phagocytose and present the antigen.

Question 20

Name and describe the 2 types of macrophages.

Answer 20

M1 (Pro inflammatory) (injury)

M2 (anti inflammatory) (repair)

Question 21

Give 1 difference between tissue injury and repair.

Answer 21

Injury involves coagulation factors.

Repair uses the process of fibrosis.

Question 22

Describe steps 2 and 3 of granuloma formation :

1. Macrophages present the antigen to lymphocytes.
2. _____________
3. _____________
4. Giant cell macrophages engulf bacteria.

Answer 22

1. Macrophages present the antigen to lymphocytes.
2. Lymphocytes (T cells) produce interleukins.
3. Induced formation of epithelioid macrophages (giant cells formation)
4. Giant cell macrophages engulf bacteria

Question 23

What type of inflammation is orofacial granulomatosis?

Answer 23

Chronic granulomatous inflammation.

Question 24

On examination, oral granulomas would present as what?

Answer 24

Swellings of the oral soft tissues.

Question 25

Describe the 2 terms given to describe oral granulomas based on medical history.

Answer 25

If intestinal crohns is present, it is termed "oral crohns". | If intestinal crohns is not present, it is termed "orofacial granulomatosis".

Question 26

What type of cells does acute inflammation involve mostly?

Answer 26

Neutrophils

Question 27

What type of cells does chronic inflammation involve mostly?

Answer 27

Macrophages

Question 28

Name the cell type which predominantly makes up inflamed epithelial tissue in gingivitis.

Answer 28

Defence cells.

Question 29

``` Describe stages 2 and 3 of tissue destruction in periodontitis. 1. Initiation of immune response Recruitment of immune cells Immune cell activation 2. _____________ 3. _____________ 4. Activation of MMPs. ```

Answer 29

1. Initiation of immune response Recruitment of immune cells Activation of immune cells 2. RANKL production (apoptosis regulator) 3. Activation of osteoclasts (resorb bone) Reduced function of osteoblasts 4. Activation of MMPs.

Question 30

The ECM made up of many _____________ fibres.

Answer 30

Collagen

Question 31

What can the ECM be remodelled by?

Answer 31

MMPs

Question 32

What is angiogenesis?

Answer 32

The formation of new blood vessels.

Question 33

Name the process of : 1. Bone formation 2. Bone resorption

Answer 33

1. Bone formation - osteoblastogenesis | 2. Bone resorption - osteoclastogenesis

Question 34

How often do we get a new skeleton?

Answer 34

Every 10 years

Question 35

Which cell type do osteoclasts differentiate from?

Answer 35

Macrophages

Question 36

Which cell produced RANKL?

Answer 36

Osteoblasts

Question 37

Which receptor does RANKL activate? Where is it?

Answer 37

RANKL activates RANK (receptor) on osteoclasts.

Question 38

Why is RANKL production controlled?

Answer 38

If it were uncorntrolled, osteoclasts would constantly be activated so bone would always be resorbed. It prevents excessive bone resorption.

Question 39

What do osteoblasts also secrete in addition to RANKL? Why is this important?

Answer 39

Osteoblasts secrete osteoprotogerin (OPG) which inhibits RANKL.