The Science of Rheumatoid Arthritis

Question 1

The two ends of bones coming together to make a joint are lined with what?

Answer 1

Articular cartilage

Question 2

Functions of synovium?

Answer 2

Lubrication of cartilage
Control of synovial fluid volume
Nutrition of chondrocytes within joints
Maintenance of intact tissue surface

Question 3

How does the synovium link to rheumatoid arthritis?

Answer 3

Synovitis is hallmark of rheumatoid arthritis

Question 4

Cells in lining of synovium?

Answer 4

Macrophages
Fibroblasts- maintenance of lubrication

Question 5

What happens to a joint affected by rheumatoid arthritis?

Answer 5

Thickening of synovium due to inflammation aka synovitis

Question 6

What effect does synovitis have on bone and cartilage?

Answer 6

Causes erosion

Question 7

Rheumatoid arthritis?

Answer 7

Chronic symmetric polyarticular inflammatory joint disease

(say that five times fast)

Question 8

In rheumatoid arthritis, what is the synovitis characterised by?

Answer 8

Inflammatory cell infiltration, fibroblast proliferation and neoangiogenesis

Question 9

Rheumatoid arthritis is an autoimmune disease.
What can be associated with rheumatoid arthritis?

Answer 9

Autoantibodies e.g. rheumatoid factor and anti-citrullinated protein antibodies

->these autoantibodies can contribute to inflammation

Question 10

Which autoantibodies are usually checked for?

Answer 10

ACP antibodies- more specific
Rheumatoid factor

Question 11

What does rheumatoid factor recognise of self?

Answer 11

IgG

->so recognises it as mot being part of ourselves I think so tries to destroy

Question 12

Genetics play a part in the pathogenesis of rheumatoid arthritis, what are some of the environmental factors
?

Answer 12

Smoking
Infectious agents e.g. E.Coli

Question 13

What process occurs in the ACP antibodies response in rheumatoid arthritis?

Answer 13

Citrullination

Question 14

What happens in citrullination?

Answer 14

Conversion of arginine (amino acid) into citrulline (another amino acid)

Question 15

What enzyme is responsible for the conversion of arginine into citrulline?

Answer 15

Peptidylarginine deiminases (PADs)

Question 16

What is the pathological hallmark of RA>

Answer 16

Synovitis

Question 17

What is synovitis characterised by?

Answer 17

Intima hyperplasia with infiltration of mononuclear cells e.g. CD4+ T cells, macrophages and B cells

Question 18

Describe what happens in synovitis.

Answer 18

Villous hypertrophy
Infiltration of T cells, B cells and macrophages
Intimal cell proliferation
Production of cytokines and proteases
Increases vascularity

Question 19

What do inflammatory cytokines activate?

Answer 19

Synovial fibroblasts
Chondrocytes
Osteoclasts

Question 20

Neoangiogenesis?

Answer 20

Production of new blood vessels

->occurs in synovitis as provides nutrients to hyperplastic synovium

Question 21

What does the destruction of cartilage and bone cause?

Answer 21

Joint space narrowing and erosions

Question 22

Which cells mediate bone destruction?

Answer 22

Osteoclasts

Question 23

What are the key cytokines in chronic inflammatory arthirits?

Answer 23

TNF-alpha
IL-1
IL-6
RANK-ligand
IL-17

Question 24

Systemic consequences of rheumatoid arthritis?

Answer 24

CVD
Fatigue
Liver
Lungs
Muscles- sarcopenia
Bone- osteoporosis
Secondary Sjogren’s syndrome