medyo final patho slide orientation
TRANSCRIPT
Etiology
Cause remains unknown Factors that contribute to development,
progression and chronicity : Genetic Susceptibility▪ HLA-DRB1: shared epitope is specific binding site of
arhritogens▪ PTPN22: activation and control of inflammatory cells
Environmental arthritogens▪ Microbial agents▪ Citrullinated proteins
Autoimmunity▪ Rheumatoid factors
Genetic susceptibilityArthritogens
Activation of CD4+ helper T cells
Release of cytokinesINF-γ & IL-17
Stimulation of synoviocytes and macrphages
Production of pro-inflammatory molecules:IL-1, 6, 23, TNF, PGE2, NO,GF, GM-CSF, TGF-β
Increase production of
cartilage matrix metalloproteina
ses
Stimulation of osteoclastogenesis
and osteoclast activity
Synoviocytes up-regulate vascular
cell-adhesion molecule
Edematous, hyperplastic, sticky synovium
Pannus formation and resorption of the adjacent bone
PATHOGENESIS
Histologic Morphology
Inflammatory infiltrate composed of lymphoid aggregates
Increased vascularity
Accumulation of neutrophils
Pannus formation
Clinical Significance
Manifestations: Mild general aching and stiffness Inflammation may be apparent first in the wrists
and fingers Joints appear red and swollen and often very
sensitive to touch as well as painful Joint stiffness “burned out” Systemic signs are marked during exacerbations
and inclued fatique, anorexia, mild fever, lymphadenopathy and genralized aching
Clinical Significance
Complications: Effects on the Skin▪ Rheumatoid Nodules
Eye Complications▪ Inflammation of the episclera▪ Scleritis▪ Sjogren's syndrome
Effects on Heart and Blood Vessels Pericardial Effusion Pericarditis Myocarditis
Diseases of the Blood and Blood-Forming Cells Anemia Felty's syndrome