Science of RA

Question 1

Stages of RA development

Answer 1

1- Citrullination of protein/ development of RF antibodies
2- Release of antibodies/ T cells into circulation- reach the joint
3- T- cells release cytokines and activate macrophages
4- Formation of panes
5- increase in RANK-L receptors on proteins –> osteoclasts activated
6- Antibody binding and formation of complement

Question 2

which cytokines do T cells release?

Answer 2

IN-17

IN- gamma

Question 3

what cytokines do macrophages release?

Answer 3

IL-6
TNF- alpha
IL-1

Question 4

What is the pannus?

Answer 4

Thick swelling of the synovial membrane containing inflammatory cells, fibroblasts

Question 5

What are RANK-L and what do they lead to?

Answer 5

RANK-L are receptors on T- cells which increase in number after panes formation.
They bind to RANK receptors and lead to the activation of osteoclasts and therefore Bone breakdown

Question 6

which antibodies are released into circulation?

Answer 6

ANTI-CCP: anti- cirtullinate poteins

Anti- RF: rheumatoid factor antibodies

Question 7

what is citrullination and does it lead to?

Answer 7

Citrullination is the process in which arginine is converted into citrulline and changes the structure of self-antigens so that antibodies can no longer recognise them

Question 8

what are some of the systemic complication of RA

Answer 8

Bones: ostoeporosis 
Lungs: fibrosis 
Liver:  anaemia 
CVS: altered lipid metabolism , increased endothelial activation 
Muscles: sarcopenia 
Inflammation

Question 9

How does anaemia develop in the liver?

Answer 9

IL-6 leads to the increased production of Hepcidin by hepatocytes
Hepcidin is an iron regulatory hormone

Question 10

Give some of the examples of vasculitis associated with RA?

Answer 10

• Scleritis
• Vasculitis
• Nodules
• Amyloidosis