Unit 3

Autoimmune Disorders

MLAB 1335 – Immunology

Part Three – Rheumatoid Arthritis
 Rheumatoid Arthritis (RA)
• Chronic systemic inflammatory disease primarily affecting the joints, but
can affect heart, lung and blood vessels.
• Immune complexes form and activate complement and the inflammatory
response.
• Enzymatic destruction of cartilage is followed by abnormal growth of synovial
cells, results in the formation of a pannus layer.

• Women three more times as likely as men to have it.

• Higher in women more than 65 years of age

• Typically strikes at ages between 25 and 55, but can occur at any age.

• The three major symptoms of arthritis are joint pain, inflammation,

and stiffness.
 Rheumatoid Arthritis (RA)

• RA has been associated with more than 30 genetic regions of our DNA
• Patients who have
• HLA-DRB1 alleles
• PTPN22 gene polymorphisms
• These patients are positive for rheumatoid factor (RF) or antibodies to
CCP ( cyclic-citrullinated peptides)
• Anti-CCP good marker for early diagnosis – performed by ELISA
• Specificity of anti-CCP is 91% to 93%
• Patient also tested for RF
• Autoantibody is usually IgM and reacts with the Fc portion of IgG
• Approximately 70% to 90% test positive for RF
• May be found in other connective tissue diseases, resulting in false pos for RA
 RA Signs/Symptoms
• Diagnosis based on
• Joint pain, stiffness and swelling for more than 6 weeks
• Swelling affecting 3-4 different joints or more
• Morning stiffness lasting longer than 30 minutes
• Symmetrical symptoms affecting both sides of the body
• Swelling and pain affecting the wrists, hands and finger joints
• Subcutaneous nodules
• Positive Anti-CCP
• Elevated ESR and CRP
• Positive test for rheumatoid factor
• X-ray evidence of joint erosion
 RA Immunologic Findings
• Rheumatoid Factor (RF) is an IgM autoantibody directed against the Fc
portion of the IgG molecule, it is an anti-antibody.
• Not specific for RA, found in other diseases.
• Latex agglutination tests – good for 70 to 90% of RA cases
• Now ELISA, chemiluminescence or nephelometry – increased specificity
• Anti-CCP – good marker for early disease
• Combination of the two has a specificity of 98% to 100% for an accurate
diagnosis
 RA Laboratory Testing
• In addition to RF and Anti-CCP testing
• ESR used to monitor inflammation
• C-Reactive Protein is utilized to monitor inflammation
RA compared to other joint disease states
RA
 RA Treatment
• Goal to achieve lowest level of disease, remission if possible
• Minimize joint damage
• Rest
• Non-steroidal anti-inflammatory drugs (NSAIDs) control swelling and pain
• Methotrexate – thought to inhibit adenosine metabolism and T-cell activation
• Substantial functional loss seen in 50% of patients within 5 years
• Slow acting anti-rheumatic drugs are coming into use but have side effects
• Joint replacement
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