Artrite reumatoide

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Artrite reumatoide

• malattia infiammatoria cronica, multifattoriale,
  immuno-mediata
• prevalenza compresa tra 0.3 e 1 MF 13
  colpisce tutte le età picco di incidenza 50 anni
• colpisce elettivamente la membrana sinoviale
  delle articolazioni diartrodiali, delle guaine
  tendinee e delle borse sierose
• la sinovite cronica provoca erosioni cartilaginee
  e ossee, rotture tendinee e legamentose con
  conseguente deformità e invalididità
• Possibili manifestazioni sistemiche , talora
  gravi, inclusa aterosclerosi accelerata
• Caratteristiche salienti poliartrite cronica
  simmetrica, erosioni ossee Rx, positività del
  fattore reumatoide e degli anticorpi anti-peptidi
  citrullinati

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genes
environment
RHEUMATOID ARTHRITIS
HLA-DR4 PTPN22 CTLA-4 PADI4
cigarette smoking microorganisms stress
PRE-ARTICULAR OR LYMPHOID PHASE
autoimmunity
RF ACPA collagen-specific response GP39-specific
response
ARTICULAR PHASE
chronic synovitis
joint damage
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Rheumatoid Synovitis
NORMAL SYNOVIUM
RHEUMATOID SYNOVIUM
LINING
ACTIVATED MACROPHAGES ACTIVATED FIBROBLASTS T
CELLS B CELLS PLASMACELLS DENDRITIC CELLS (FDC,
MYELOID DERIVED)
FIBROBLASTS MACROPHAGES
SUBLINING
Laboratorio di Reumatologia Fondazione IRCCS
Policlinico San Matteo, Pavia
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Pannus formation
Invasive pannus
bone
cartilage
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Joint damage in Rheumatoid Arthritis
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American College of Rheumatology 1987 Criteria
for the Classification of Rheumatoid Arthritis

• 1. Morning stiffness
• 2. Arthritis of 3 or more joint areas
• 3. Arthritis of hand joints (wrists, MCPs,PIPs)
• 4. Symmetric arthritis
• 5. Rheumatoid nodules
• 6. Serum rheumatoid factor
• 7. Radiographic changes
• For classification purposes, a patient shall be
  said to have rheumatoid arthritis if he/she has
  satisfied at least 4 or these 7 criteria.
  Criteria 1 through 4 must have been present for
  at least 6 weeks. Patients with 2 clinical
  diagnoses are not excluded.
• Arnett FC, et al.Arthritis Rheum 1988

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ARTRITE REUMATOIDE (3 anni dallesordio)
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ARTRITE REUMATOIDE (13 anni dallesordio)
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ARTRITE REUMATOIDE (3 mesi dallesordio)