1. By:
Abel, Joriz Kevin
Abergas, Unica May

2.  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

3. Genetic susceptibility
Arthritogens
Activation of CD4+ helperT cells
Release of cytokines
INF-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
metalloproteinases
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

5.  Inflammatory infiltrate composed
of lymphoid aggregates
 Increased vascularity
 Accumulation of neutrophils
 Pannus formation

7.  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

8.  Complications:
 Effects on the Skin
▪ Rheumatoid Nodules
 Eye Complications
▪ Inflammation of the episclera
▪ Scleritis
▪ Sjogren's syndrome

9.  Effects on Heart and BloodVessels
 Pericardial Effusion
 Pericarditis
 Myocarditis
 Diseases of the Blood and Blood-Forming
Cells
 Anemia
 Felty's syndrome

10.  Lung Problems
 Emotional Effects
 Susceptibility to Infection