Pathogenesis and Pathology of
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Rheumatoid Arthritis"Rheumatoid" : Why?
? Rheum : flow
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~ oid: resembling
Serum
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Phlegm? Attributed to humors
Blood
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? Hippocrates
Black bile
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? 4 bodily fluids? Increased substance flows and settles in joints
rheumatism
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? Paracelsus (1493-1511): substances that could not be
passed in urine precipitated in joints, and caused
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arthritis.? Autoimmune disease
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? Where do the antibodies/ Ag-ab
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complexes come from?
? Molecular mimicry?
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? Environmental triggers leadingto citrul ination of self
proteins? new epitopes?
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Anti-ccp antibodies
"cyclic citrul inated peptide"
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? Rheumatoid factor(autoantibody against Fc
portion of IgG)
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? HLA-DRB1 al eles present
arthritogen?
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Lumen
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? What do the Antigen antibody
complexes contain?
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? Citrullinated fibrinogen? Enolase
? Collagen
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? Vimentin
? Why are some joints affected
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more commonly than others?SUMMARY
50% risk
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attributable
IL-17
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IFNMacrophage
TNF
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IL-1
Synovium
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Cartilage
Papil ae
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Synovial hyperplasiaLymphoid follicles
Normal Synovium
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papil ae
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Synovial hyperplasia
Normal Synovium
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Synovial hyperplasiaPlasma cel s
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Rheumatoid noduleFibrinoid necrosis
Palisading histiocytes
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Palisading histiocytes
Fibrinoid necrosis
Points to remember
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? Anti ? ccp antibodies
? Rheumatoid factor
? HLA-DRB1 alleles
? Pannus formation
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? Synovial hyperplasia, lymphoid follicles, plasma cells
? Fibrin
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? Rheumatoid nodule? Necrosis with palisading histiocytes
? Differences between Rheumatoid and Osteoarthritis
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