Rheumatoid Arthritis

Question 1

Rheumatoid Arthritis is a systemic autoimmune disease T/F

Answer 1

True

Question 2

What is Rheumatoid Arthritis classed as?

Answer 2

A chronic, progressive, systemic, inflammatory disorder affecting synovial joints.

Question 3

What age range does RA develop?

Answer 3

25-50

Question 4

Is RA most common in males or females?

Answer 4

Females

Question 5

What do 70% of RA patients express?

Answer 5

HLA-DR4

Question 6

What environmental factors can be an influence of getting RA?

Answer 6

Smoke, pollution, occupation exposure to mineral oil an silica, infectious agents, female hormones

Question 7

What sort of infections can cause RA?

Answer 7

Mycobacterium, Streptococcus, Mycoplasma, Epstein-Barr virus, Parvovirus

Question 8

What is the first stage of RA?

Answer 8

1. Initiator phase - an event/reason for joint specific localisation. -Causes APCs and citrillination of proteins these are now seen as non-self and the immune response is triggered

Question 9

What is stage 2 of inflammation?

Answer 9

2. Inflammation phase - Self antigens (citrillinated proteins) are presented causing
   -Clonal expansion of T and B cells
   -Insufficiently controlled by Tregs
   -T and B cells are activated within the joint and this is what we don’t want

Question 10

What is stage 3 of inflammation?

Answer 10

3. Self perpetuating phase
   -Inflammatory damage in synovium causes self antigens previously ‘unseen’ by immune system to be exposed
   -> Immune response against cartilage
   -> Infiltration of immune cells
   –> Self antigens released, immune system not seen before and then the immune response occurs meaning infiltration of immune cells in cartilage, this causes the immune response.

Question 11

What is stage 4 of inflammation?

Answer 11

4. Destruction phase
   -Synovial fibroblasts and osteoclasts which are activated by cytokines (TNF, IL,6)
   -> Destruction of bone and cartilage, this is where the real damage in the tissue occurs.

Question 12

What is the role of a B cell in RA?

Answer 12

This produces antibodies which can activate the complement system and bind to activated macrophages in the synovium, these macrophages perpetuate inflammation.

Question 13

What is the role of autoantibodies in RA?

Answer 13

Rheumatoid factor (RF), and Anti-citrullinated peptides (Anti-CPP) are directed against antigens commonly present outside of the joint.

Question 14

What is the role of T cells in RA?

Answer 14

Potentially activate monocytes, macrophages and synovial fibroblasts which produce TNF-a, IL-1 and IL-6.

Question 15

What does TNF-a, IL-1 and IL-6 induce?

Answer 15

The production of matrix metalloproteinases (MMPs), which degrade the cartilage.
-Joint destruction might be caused by CD4 T-cell cytokine, the RANK ligand promotes osteoclasts to resorb bone.