文档介绍：RHEUMATOID ARTHRITIS (RA) Jiang Lindi (Zhongshan Hospital)
What is RA?
RA is a chronic polyarticular inflammatory arthritis that involves not only small joints of the hands and feet but also ans.
Pathologic change: chronic synovitis with pannus (血管翳)formation.
It will cause bony destruction, deformation, disability if joint inflammation repeatedly occur.
RF is present in the sera of more than 75%of patients.
The prevalence rate of RA has been estimated to be %-% in China, Women appear to be affected three times monly than men.
ETIOLOGY
Infectious agents: Epstein-Barr virus, mycoplasma, macobacteria, retroviruses
T lymphocyte and macrophage activation
B lymphocyte activation
Change of the gene expression
Molecular mimicry
2. ic factors
A high incidence among monozygotic twins (30% ~50%),first-degree relative
Role of HLA-DR4 in the susceptibility to and severity of RA
70% RA patients ,a relative risk of having RA with HLA-DR4 of 4 to 5
The susceptibility epitope (shared epitope 共同表位): QKRAA或QRRAA
It was considered to be related with the severity of established RA
3. Gender:
Predominance in women
Improvement or remission of RA during pregnancy
factors: tiredness, humidity, cold, mulnutrition, psychical stimuli
antigen :HLA-DR(QKRAA)、heat shock protein、IgG、type II collagen
antigen processing
macrophages +MHCII-plexes
presentation
T cell
cytokine(IL-1、2、3、4、 6、TNF、r-INF)
B cell activation
immune damage RF and other antibody
collagenase、stromolysin
cartilage and bone destruction extra-articular symptom
PATHOLOGY
PATHOLOGIC FINDING
1. chronic synovitis
In acute phase: effusion and cell infiltration
In chronic phase:
the number of A type cell remarkably increases
the pannus erodes cartilage, bone, ligaments and tendons.
2. extra-articular:vasculitis、rheumatoid nodule
CLINICAL FAETURES
The usually age at onset is 35-50 years
The ratio of female to male is 3:1
The onset of RA is usually insidious
Systemic symptom