姜林娣－类风关.ppt

 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 systemic organs. 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 0.32%-0.36% in China, Women appear to be affected three times more commonly 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. Genetic 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 4.Induced factors: tiredness, humidity, cold, mulnutrition, psychical stimuli antigen :HLA-DR(QKRAA)、heat shock protein、IgG、type II collagen antigen processing macrophages +MHCII-peptide complexes 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 ce