Hudig: Immunology of RA Flashcards
Identify major differences between osteoarthritis and rheumatoid arthritis.
osteoarthritis: occurs without immune infiltration or inflammation. It occurs as a matter of overuse.
Contrast juvenile rheumatoid arthritis (JRA) vs. adult rheumatoid arthritis (RA).
JRA is uncommon and presents at or before age 16 whereas rheumatoid arthritis is a common disease typically presents around 40-60 years of age. Fever, rash, adenopathy, splenomegaly and iridocyclitis are symptoms of some of the JRA patients whereas most of these symptoms are usually absent from RA.
Describe the symptomatic course and timeline of rheumatoid arthritis.
If diagnosed early, first soft tissue swelling, then loss of cartilage and bone. Stabilized and slower damage after xx years.
Describe 2 major aspects of the joint disease of RA
- Occurs in hands and feet rather than back.
2. Thickening of synovial membrane, with loss of both cartilage and bone.
2 common systemic manifestations of rheumatoid arthritis.
Systemic weakness
malaise
low grade fever
fatigue in the afternoon
Identify 5 types of immune cells that inside rheumatoid lesions
dendritic cells macrophages CD4 T cells (Tregs, T17, T follicular helper cells) plasma B cells PMNs (neutrophils)
Which of the immune cells in rheumatoid arthritis produces TNF alpha?
DCs
macrophages
Which of the immune cells produce IL6?
dendritic cells
What are 2 major aspects of RA that Dr. Hudig highlighted in red?
synovitis in more than 1 joint
number and site of joints involved
Which form of arthritis has synovial lymphocytes >2000/uL and anti-citrullinated peptide antibody?
rheumatoid arthritis
In RA, you need 4 out of 5 of the following symptoms:
morning stiffness > or = (blank) hours
arthritis of >(blank) joints for > (blank) weeks
arthritis of (blank) joints
radiographic bone (blank)
yellow turbid synovial fluid with 10-15000 cells/uL, >50%PMNs, no crystals
1 hour;
3 joints; 5 weeks;
hand;
erosions/decalcification;
What will you see histologically in RA?
finger-like protrusions of inflamed and oedematous fibrovascular stroma covered by plump epithelial cells
Are cytotoxic T cells and NK cells found in rheumatoid arthritis?
no!
Macrophages at the joint site secrete (blank) which induces (blank) in fibroblasts. (blank) activates osteoclasts for bone destruction
IL-1; RANKL; RANKL
**so macrophages release IL-1 which causes RANKL production in fibroblasts and RANKL activates osteoclasts
In the healthy joint, the thin synovial membrane lines the non-weight-bearing aspects of the joint. In rheumatoid arthritis, the synovial membrane becomes hyperplastic and infiltrated by chronic (blank). Ultimately it develops into (blank), which migrates onto and into the articular cartilage and underlying bone.
inflammatory cells; pannus
