Rheumatoid Arthritis ( Ra )

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Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease that is systemic in nature but primarily targets and damages the synovial joints. It is characterized by painful, swollen, stiff joints, which manifest primarily in the hands, wrists, elbows, knees, ankles, and feet. RA is more common among women than men and increases in prevalence with age, however it can also occur in young adults and children (Lee & Weinblatt, 2001). Physiology Behind the Condition Although the exact cause of RA is still unknown, investigation into this disease has provided an increased understanding of the biological mechanisms that occur (Bingham, 2013). Research has considered both genetic and environmental factors that could trigger the onset…show more content…
RA begins with plasma cells overproducing rheumatic factors (RF) and antibodies to citrullinated protein antigen (ACPA). RF and ACPA can cause damage as well as activate macrophages, which play a large role in inflammation of the rheumatic synovium by drastically increasing the number of proinflammatory cytokines in the joint (Arend, 2001). Tumor necrosis factor alpha (TNF- α), interleukin-1 (IL-1) and interleukin-6 (IL-6) are the main cytokines involved in RA, which attract immune cells to the joints and cause tissue destruction (Arend, 2001). In addition, macrophages will also activate B and T cells via their MHC class II (Lee & Weinblatt, 2001). B and T cells are thought to play a role in the systemic aspects of RA but have an unclear function in synovial joints (Lee & Weinblatt, 2001). It does not take long for the effects of inflammation to arise in an individual with RA. They will likely experience symptoms of heat, redness, swelling and pain in their joints due to the rapid increase in the number of immune cells, which causes thickening of the synovial lining (Lee & Weinblatt, 2001; NIAMS, 2014). Then, granulation tissue called pannus will begin to develop in the synovial joint which will prevent nutrients from accessing the site, leading to disintegration of bone cartilage (Lee & Weinblatt, 2001; Madsen, 2011). In
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