Rheumatiod Arthritis

Question 1

Initiation (preclinical stage)

Answer 1

Autoimmune activation begins, production of Autoantibodies - rheumatoid factor &
anti-citrullinated protein antibodies (ACPA’s)
Immune cells (T-cells & B-cells) activate
Biomarkers (RF, ACPA’s) may be detectable in blood

Question 2

Early stage (inflammatory stage)

Answer 2

Inflammatory infiltrates, including macrophages, invade the synovium
Synovial hyperplasia begins
Cytokines contribute to inflammation & tissue damage

Presentation -
Symmetrical joint pain, swelling, stiffness (morning +30mins)
Commonly affects small joints- wrists, MCP, PIP)
Fatigue, fever

Question 3

Established RA

Answer 3

Pannus grows, eroding cartilage, subcondral bone & tendons
Angiogenesis increases vascular supply to the inflamed synovium
Osteoclast activation leads to bone erosion

Prevention -
Persistent joint inflammation
Ulnar deviation, swan neck deformity
Decreased ROM
Weight loss
Malaise

Question 4

Late RA (destructive stage)

Answer 4

Extensive bone and cartilage destruction
Fibrosis and scarring within the joint
Ankylosis in severe cases

Presentation -
Severe joints deformity & immobility
Cardiovascular complications
Nodules
Lung disease

Question 5

What is it?

Answer 5

Rheumatoid arthritis (RA) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own tissues, primarily the joints. Unlike osteoarthritis, which is due to wear-and-tear, RA is an inflammatory condition that can affect multiple joints and even other systems in the body. It usually begins in smaller joints, such as those in the hands and feet, and progresses to larger joints over time.
HLA-DRB1