The Science of Rheumatoid Arthritis

Question 1

What are the functions of synovium?

Answer 1

Maintenance of intact tissue surface
Lubrication of cartilage
Control of synovial fluid volume and composition (hyaluronan, lubricin)
Nutrition of chondrocytes within joints

Question 2

What is rheumatoid arthritis?

Answer 2

A chronic symmetrical polyarticular inflammatory joint disease, which primarily affects the small joints of the hands and feet

Question 3

What is contained in the synovial fluid in the joint cavity?

Answer 3

Neutrophils

Question 4

How is rheumatoid synovitis (pannus) characterised?

Answer 4

Inflammatory cell infiltration, synoviocyte proliferation and neoangiogenesis

Question 5

Which autoantibodies are comonly associated with RA?

Answer 5

Rheumatoid factors and anti-citrullinated protein antibodies

Question 6

What is seropositive rheumatoid arthritis?

Answer 6

Rheumatoid factor
Anti-citrullinated protein antibody (ACPA)
Diagnostic anti-CCP assays recognise citrullinated self-proteins
Patients with ACPA+ disease have a less favourable prognosis

Question 7

Environmental factors that contribute to RA

Answer 7

Smoking and bronchial stress (exposure to silica)
Infectious agents
Repeated insults in a genetically susceptible individual

Question 8

Inflammatory cytokines

Answer 8

Induce expression of endothelial-cell adhesion molecules
Activate synovial fibroblasts, chondrocytes, osteoclasts
Promote angiogenesis
Suppress T-regs
Activate leukocytes
Promote autoAb production
IL-6 mediates systemic effects