Lecture 12-Rheumatoid Arthritis

Question 1

What type of disease is rhematoid arthritis?

Answer 1

A slow, progressive disease caused by inflammation which typically effects small joints in hands, wrists and feets

Question 2

Which region of the body does rhematoid arthritis typically NOT affect?

Answer 2

The thoracic or Lumbar spine (the cervical region may be affected)

Question 3

What occurs to the synovial membrane in rheumatoid arthritis?

Answer 3

The syovial membrane becomes inflammed, in a condition known as synovitis

This results in a thickened, hypertrophied with many immune cells including lymphocytes and macrophages

The synovial membrane extends over joint cartilage and bone causing erosion as a result of increased oestoclast activity

Tendon sheaths are inflamed bas they are lined by synovium

Question 4

What are the potential factors which could potentially contribute to rheumatoid arthritis?

Answer 4

Molecular mimicry, autoantibodies, genetic susceptibility and cytokines

Question 5

How does molecular mimicry contribute to rheumatoid arthritis?

Answer 5

A cross reactive immune reaction could occur aimed at self antigens like type II collagen

Question 6

How do autoantibodies contribute to rheumatoid arthritis?

Answer 6

Their can be antibodies targeted at the Fc region of their own antibodies this results in more severe disease

Question 7

What role does genetic susceptibility play in rheumatoid arthritis?

Answer 7

Roughly 50-60% of the risk of developing the disease

Typically the HLA genes for MHC are affected, as these play a key role in regulating the immune response

Question 8

What role do cytokines play in rheumatoid arthritis?

Answer 8

Proinflammatory cytokines (TNFalpha, IL-1, IL-6) are released inside the joint in rheumatic arthritis

GM-CSF prmotoes neutrophil development which produce destructive enzymes metalloprotienases, these affect the foint as there is upregulation of the adhesion molecules in the synovium

Question 9

While rheumatoid arthritis is extreemly variable in its symptoms and severity what are some of the symptoms associated with it?

Answer 9

Widspread pain, swelling and stiffness in joints this is typicaly symmetrical throughout the body

Often the stiffness is worse in the mornings than in the evenings

There is typically limitations in joint movement due to deformity casued by rheumatoid arthritis

There can also be wasting, depression and mild fever

Question 10

What are the potential consequences if rheumatoid arthritis spreads out of the joint to affect other tissues?

Answer 10

Rheumatoid nodules can appear under the skin

Lung involvment can occur

Blood vessels may become inflamed

Lymphoid and splenic enlargement may occur (still’s diseases)

Nerves can be entraped

‘Eyes can becoe inflammed and grow dry (Sjogren’s syndrome)

Question 11

What are the possible treatment options for rheumatoid arthritis?

Answer 11

Analgesics and anti-inflammatory drugs can provide symtpom relief

Corticosteroids can suppress the inflammatory response

Disease modifying anti-rheumatic drugs may be used to suppresssome of the immune cells (Methotrexate, leflunomide, sulphasalazine)

Biologics, or engineered molecules that inhibt parts of the immune response such as those acting as competitive inhibitors for the TNF and TNFalpha receptors or those supressing costimulants of B and T cells