Rheumatoid Arthritis Overview
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Questions and Answers

What is the percentage of patients with RA who test positive for RF over the course of their disease?

  • 90-100%
  • 40-60%
  • 80-90%
  • 60-80% (correct)

    • What is the significance of the presence of RF in patients with RA?

  • It has no correlation with the disease progression.
  • It predicts a slower progression of bone erosions.
  • It predicts radiographic progression of bone erosions independent of disease activity. (correct)
  • It is only present in early RA.

    • What is the frequency of positive results for ANA assays in patients with RA?

  • 30% of patients
  • 20% of patients
  • 40% of patients (correct)
  • 50% of patients

    • What is the significance of ACPA-positive patients?

    <p>They have a more erosive RA disease course.</p> Signup and view all the answers

    What is the sensitivity and specificity of anti-CCP assays compared to RF assays?

    <p>Higher sensitivity and specificity</p> Signup and view all the answers

    What is the significance of the presence of both anti-CCP antibodies and RF in patients with RA?

    <p>It is highly specific for RA.</p> Signup and view all the answers

    What is the significance of the presence of anti-CCP antibodies in patients with RA?

    <p>It indicates a worse prognosis.</p> Signup and view all the answers

    Which of the following laboratory studies is NOT a marker of inflammation?

    <p>Complete blood count (CBC)</p> Signup and view all the answers

    What is thrombocytosis associated with in patients with RA?

    <p>Disease activity</p> Signup and view all the answers

    What percentage of healthy people may have RF present?

    <p>1-5%</p> Signup and view all the answers

    Study Notes

    Rheumatoid Arthritis (RA)

    • RA is an autoimmune, systemic, symmetrical, chronic inflammatory polyarthritis that involves small peripheral joints, with articular and extra-articular manifestations.
    • It is classified as an immune-mediated inflammatory disease (IMID).

    Characteristics

    • RA affects mostly women, with a female-to-male ratio of 3:1.
    • It is characterized by synovial inflammation and hyperplasia, leading to joint damage and deformities.

    Pathogenesis

    • Adaptive and innate immunity play fundamental roles in initiating, propagating, and maintaining the autoimmune process of RA.
    • T cells, B cells, antigen-presenting cells, and various cytokines are involved in the pathologic process.
    • Abnormal production and regulation of proinflammatory and anti-inflammatory cytokines and cytokine pathways are found in RA.

    Immune Cells

    • T cells: produce pro-inflammatory cytokines, mediate T-cell activation, and stimulate macrophages and fibroblasts.
    • B cells: secrete proteins supporting RA, such as rheumatoid factors (RFs) and anti-citrullinated protein antibodies (ACPAs).
    • Macrophages: secrete cytokines, leading to inflammation and transforming into tissue-destructive cells.
    • Synovial fibroblasts: proliferate, producing cytokines and chemokines, leading to bone erosion.

    Laboratory Studies

    • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level: markers of inflammation.
    • Complete blood count (CBC): hematologic parameters, including thrombocytosis, associated with disease activity.
    • Rheumatoid factor (RF) assay, antinuclear antibody (ANA) assay, and anti-cyclic citrullinated peptide (anti-CCP) antibody: immunologic parameters.

    Rheumatoid Factor (RF)

    • An immunoglobulin (Ig) M antibody directed against the Fc fragment of IgG, present in approximately 60-80% of patients with RA.
    • Predicts radiographic progression of bone erosions, independent of disease activity.
    • Not specific for RA, also present in other connective tissue diseases, infections, and autoimmune disorders.

    Anti-Citrullinated Protein Antibody (ACPA)

    • Assays for anti-citrullinated protein antibody (ACPA; often tested as anti-CCP) are used clinically for diagnosing RA.
    • ACPA-positive patients may have a more erosive RA disease course than ACPA-negative patients.
    • The presence of both anti-CCP antibodies and RF is highly specific for RA, indicating a worse prognosis.

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    Description

    This quiz covers the definition and characteristics of Rheumatoid Arthritis, an autoimmune and chronic inflammatory disease that affects the joints.

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