Rheumatoid Arthritis Chapter
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Questions and Answers

What is Rheumatoid Arthritis characterized by?

  • Persistent inflammation (correct)
  • Intermittent inflammation
  • Chronic inflammation
  • Acute inflammation

    • What is the primary target of Rheumatoid Arthritis?

  • Large joints of the body
  • Knee and elbow joints
  • Spine and hip joints
  • Small joints of the hands and feet (correct)

    • What is the common symptom of Rheumatoid Arthritis?

  • Numbness in the joints
  • Stiffness in the morning
  • Fever and chills
  • Pain and swelling in affected joints (correct)

    • What is the duration of morning stiffness in Rheumatoid Arthritis?

    <p>Greater than or equal to 1 hour</p> Signup and view all the answers

    What contributes to the development of Rheumatoid Arthritis?

    <p>Genetic predisposition and environmental factors</p> Signup and view all the answers

    What mediates the pathologic changes in Rheumatoid Arthritis?

    <p>Both inflammation caused by cytokines and antibodies against self-antigens</p> Signup and view all the answers

    What is the result of increased osteoclast activity in Rheumatoid Arthritis?

    <p>Destruction of cartilage</p> Signup and view all the answers

    What can be a complication of Rheumatoid Arthritis?

    <p>Ankylosis of the joints</p> Signup and view all the answers

    What is associated with anti-citrullinated protein antibodies-positive RA?

    <p>HLA class II locus</p> Signup and view all the answers

    What is the function of the protein encoded by the PTPN22 gene?

    <p>Inhibit T cell activation</p> Signup and view all the answers

    What is the characteristic histologic feature of RA?

    <p>Dense inflammatory infiltrates of CD4+ helper T cells</p> Signup and view all the answers

    What is the age of onset for Juvenile Idiopathic Arthritis?

    <p>Before age 16</p> Signup and view all the answers

    What is more common in JIA compared to RA?

    <p>Oligoarthritis</p> Signup and view all the answers

    What is usually absent in JIA?

    <p>Rheumatoid factor</p> Signup and view all the answers

    What is common in JIA?

    <p>Anti-nuclear antibody (ANA) seropositivity</p> Signup and view all the answers

    What is a characteristic feature of RA?

    <p>Increased vascularity resulting from angiogenesis</p> Signup and view all the answers

    Which type of T cell produces cytokines that stimulate macrophages and synovial cells?

    <p>TH1</p> Signup and view all the answers

    What is the primary function of RANKL expressed on activated T cells?

    <p>Stimulating osteoclasts and bone resorption</p> Signup and view all the answers

    Which cytokine has been most firmly implicated in the pathogenesis of RA?

    <p>TNF</p> Signup and view all the answers

    What is the estimated percentage of the risk of developing RA that is related to inherited genetic susceptibility?

    <p>50%</p> Signup and view all the answers

    What is the name of the autoantibodies that bind to their own IgG?

    <p>Rheumatoid factor</p> Signup and view all the answers

    What is the percentage of RA patients who have ACPA in their blood?

    <p>70%</p> Signup and view all the answers

    What is the primary function of IL-17 from TH17 cells?

    <p>Recruiting neutrophils and monocytes</p> Signup and view all the answers

    What is the name of the process that may promote citrullination of self-proteins, creating new epitopes that trigger autoimmune reactions?

    <p>Insults</p> Signup and view all the answers

    What is the pathogenesis of JIA?

    <p>Unknown and similar to adult RA</p> Signup and view all the answers

    What type of cells are involved in damage in JIA?

    <p>TH1 and TH17 cells</p> Signup and view all the answers

    What percentage of individuals with JIA develop serious functional disability?

    <p>About 10%</p> Signup and view all the answers

    What is a common feature of Spondyloarthropathies?

    <p>Absence of rheumatoid factor</p> Signup and view all the answers

    What is the name of the antigen that triggers an immune response in Spondyloarthropathies?

    <p>Undefined antigen</p> Signup and view all the answers

    What is the prototypical Spondyloarthritis?

    <p>Ankylosing spondylitis</p> Signup and view all the answers

    What is the age range when Ankylosing spondylitis becomes symptomatic?

    <p>Second and third decades of life</p> Signup and view all the answers

    What is the percentage of patients with Reactive arthritis who are HLA-B27 positive?

    <p>More than 80%</p> Signup and view all the answers

    What is the probable cause of a disease characterized by low back pain and joint inflammation?

    <p>Autoimmune reaction initiated by previous infection of the genitourinary system</p> Signup and view all the answers

    Which of the following joints are most commonly affected in a disease characterized by low back pain and joint inflammation?

    <p>Ankles, knees, and feet</p> Signup and view all the answers

    How can infectious arthritis occur?

    <p>Through hematogenous dissemination, direct inoculation, or contiguous spread</p> Signup and view all the answers

    Which bacterial infection is most common in children younger than 2 years of age?

    <p>H.influenza</p> Signup and view all the answers

    What is the main agent causing acute suppurative arthritis in older children and adults?

    <p>S.aureus</p> Signup and view all the answers

    Which group of people is more susceptible to infection with Salmonella?

    <p>Individuals with sickle cell disease</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the classic presentation of infectious arthritis?

    <p>Gradual development of a chronic joint pain</p> Signup and view all the answers

    Who is more susceptible to disseminated gonococcal infections and hence arthritis?

    <p>Individuals with deficiencies of complement components</p> Signup and view all the answers

    Study Notes

    Rheumatoid Arthritis (RA)

    • RA is a chronic inflammatory autoimmune disease characterized by persistent inflammation that primarily affects peripheral joints, producing a non-suppurative proliferative and inflammatory synovitis.
    • It typically starts as an insidious symmetrical arthritis and has an unpredictable and variable course.
    • RA often progresses to the destruction of articular cartilage and, in some cases, ankylosis (adhesion) of the joints.
    • Extra-articular lesions may occur in the skin, heart, blood vessels, and lungs.
    • Articular manifestations include symmetric arthritis, principally affecting the small joints of the hands and feet, with pain and swelling in affected joints aggravated by movement.
    • Morning stiffness ≥1 hour is a common symptom.

    Pathogenesis of RA

    • Genetic predisposition and environmental factors contribute to the development, progression, and chronicity of the disease.
    • Pathologic changes are mediated by antibodies against self-antigens and inflammation caused by cytokines, predominantly secreted by CD4+ T cells.
    • The inflammation localizes to the joint, recruiting macrophages and triggering activation and/or proliferation of synovial cells, chondrocytes, and fibroblasts.
    • The production of proteolytic enzymes and cytokines contributes to the destruction of cartilage and bone.
    • CD4+ T helper (TH) cells may initiate the autoimmune response by reacting with an arthritogen.

    Morphology of RA

    • Grossly, the synovium becomes edematous, thickened, and hyperplastic, transforming its smooth contour to one covered by delicate and bulbous villi.
    • Histologic features include synovial cell hyperplasia and proliferation, dense inflammatory infiltrates of CD4+ helper T cells, B cells, plasma cells, dendritic cells, and macrophages, and increased vascularity resulting from angiogenesis.

    Juvenile Idiopathic Arthritis (JIA)

    • JIA is a heterogeneous group of disorders of unknown cause that present with arthritis before age 16 and persist for at least 6 weeks.
    • In contrast to RA, JIA is characterized by oligoarthritis, systemic disease, and large joints being affected more often than small joints.
    • Rheumatoid nodules and rheumatoid factor are usually absent, and anti-nuclear antibody (ANA) seropositivity is common.
    • The pathogenesis is unknown but similar to adult RA, with risk factors including HLA and PTPN22 variants.
    • Damage in JIA appears to be caused by TH1 and TH17 cells and cytokines produced by these and other inflammatory cells.

    Seronegative Spondyloarthropathies

    • Spondyloarthropathies are a heterogeneous group of disorders that share the following features:
      1. Absence of rheumatoid factor
      2. Pathologic changes in the ligamentous attachments rather than synovium
      3. Involvement of sacroiliac joints, with or without other joints
      4. Association with HLA-B27
      5. Bony proliferation leading to ankylosis (fusion of joints)

    Ankylosing Spondylitis

    • Ankylosing spondylitis is the prototypical spondyloarthritis, causing destruction of articular cartilage and bony ankylosis, especially of the sacroiliac joints.
    • The disease becomes symptomatic in the second and third decades of life as lower back pain and spinal immobility.
    • Involvement of peripheral joints, such as the hips, knees, and shoulders, occurs in at least one-third of affected individuals.
    • Approximately 90% of patients are HLA-B27 positive.

    Reactive Arthritis

    • Reactive arthritis is defined by a triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis.
    • Most affected individuals are men in their 20s or 30s, and more than 80% are HLA-B27 positive.
    • The disease is probably caused by an autoimmune reaction initiated by previous infection of the genitourinary system (Chlamydia) or the gastrointestinal tract (Shigella, Salmonella, Yersinia, Campylobacter).

    Infectious Arthritis

    • Joints can become infected from hematogenous dissemination, direct inoculation through the skin, or from contiguous spread from a soft tissue abscess or osteomyelitis.
    • Infectious arthritis is potentially serious, because it can cause rapid, permanent joint destruction.
    • Suppurative arthritis is caused by bacterial infections, usually entering the joints from distant sites by hematogenous spread.
    • The main agents include H. influenza, S. aureus, and gonococcus.
    • Individuals with sickle cell disease are prone to infection with Salmonella.

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    Understand the pathological changes of joints in Rheumatoid arthritis and other types of arthritis. Learn about the characteristics of this chronic inflammatory autoimmune disease.

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