pathology of rheumatoid arthritis
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Pathology
- cellular & humoral immune mechanisms
- destructive inflammatory response involving synovium
- joint destruction, little reparative tissue
- chronic exudative inflammation of synovium with
- hypertrophy & hyperplasia of synovial lining cells
- focal fibrinous exudation,
- infiltration by lymphocytes & plasma cells
- lymphoid follicles not uncommon
- inflamed synovium -> pannus over articular surface destroying underlying cartilage
- cadherin-11 on the surface of synovial cells triggers inflammation & synovial proliferation[2]
- secondary damage
- joint erosions occur within the 1st 2 years of disease
- vasculitis mediated by immune complex deposition
- small-vessel vasculitis usually involves the skin
- skin biopsy shows leuckocytoclastic vasculitis[4]
- large-vessel vasculitis can mimic polyarteritis nodosa
- small-vessel vasculitis usually involves the skin
- stimulation of osteoclast activity by osteoprotegerin ligand has been suggested[1]
- increased risk of cardiovascular disease thought to be inflammatory-induced
- iron-binding acute phase protein detected with variable frequency in serum of patients with rheumatoid arthritis (non-specific)
- proteins in synovial fluid in patients with RA
- autoantibodies in patients with RA
- rheumatoid factor*
- cyclic citrullinated peptide antibody*
- antinuclear antibodies (ANA)
- generally diffuse immunofluorescence pattern
- anti keratin antibodies (AKA)
- anti perinuclear factor
- anti RA33
- anti RA-associated nuclear antigen (RANA)
- anti synovial stimulatory protein p205
- anti gp130 (non-specific)
- anti MMP19
- anti ANXA11
- anti GRP78 (HSPA5)
* rheumatoid factor & cyclic citrullinated peptide antibody are associated with an increased risk of rheumatoid arthritis but neither are necessary nor sufficient to cause the disease[3]
More general terms
Additional terms
References
- ↑ 1.0 1.1 Journal Watch vol 19, #24, pg 192-93 Dec 15, 1999 Kong YY et al, Nature 402:304, 1999
- ↑ 2.0 2.1 Lee DM, Kiener HP, Agarwal SK, Noss EH, Watts GF, Chisaka O, Takeichi M, Brenner MB. Cadherin-11 in synovial lining formation and pathology in arthritis. Science. 2007 Feb 16;315(5814):1006-10. Epub 2007 Jan 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17255475
Firestein GS. Biomedicine. Every joint has a silver lining. Science. 2007 Feb 16;315(5814):952-3. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17303744 - ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
- ↑ 4.0 4.1 Seetharaman M (slide show with images) Rheumatoid Arthritis: In and Out of the Joint. Medscape. March 22, 2016 http://reference.medscape.com/features/slideshow/rheumatoid-arthritis