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heumatoid arthritis cell (RA cell) 625 rheumatoid pneumonitis
Scleritis
keratoconjunctivitis
Pleural effusion
Pericardial effusion
Bone marrow
anemia and
thrombocytosis
Rheumatoid arthritis.
Splenomegaly
Kidney amyloidosis
Gut amyloidosis
Lymphadenopathy
criteria for rheumatoid arthritis are as follows: (1) morning stiffness
in and around joints lasting at least 1 hour before maximum
improvement; (2) soft tissue swelling (arthritis) of three or
more joints observed by a physician; (3) swelling (arthritis) of
the proximal interphalangeal, metacarpal phalangeal, or wrist
joints; (4) symmetric swelling (arthritis); (5) rheumatoid nodules;
(6) rheumatoid factors; and (7) roentgenographic erosions.
CD4 + T cells, activated B cells, and plasma cells are present in
inflamed joint lining (synovium) and multiple proinflammatory
cytokines such as IL1 and TNF are found in synovial joint fluid.
The disease is accompanied by the production of rheumatoid
factor, usually an IgM anti-IgG antibody.
rheumatoid arthritis cell (RA cell)
An irregular neutrophil that contains a variable number of
black-staining cytoplasmic inclusions 0.2 to 2.0 μm in diameter.
These cells contain IgM rheumatoid factor, complement,
IgG, and fibrin and are found in synovial fluids of patients
with RA. Although RA cells may constitute 5 to 100% of
the neutrophils of RA patients, they may also be present in
patients with other connective tissue diseases.
rheumatoid factors (RFs)
An autoantibody present in the sera of patients with rheumatoid
arthritis and found with varying frequency in other diseases
such as subacute bacterial endocarditis, tuberculosis, syphilis,
sarcoidosis, hepatic diseases, and others. It may also be found
in the sera of human allograft recipients and apparently healthy
persons. RFs are immunoglobulins, usually of the IgM class
and to a lesser degree of the IgG or IgA classes, with reactive
specificity for the Fc region of IgG. These anti-immunoglobulin
antibodies that may be monoclonal or polyclonal react with the
Fc region epitopes of denatured IgG, including the Gm markers.
Most RFs are isotype-specific, manifesting reactivity mainly
for IgG 1, IgG 2, and IgG 4, and are only weakly reactive with
IgG 3. Antigenic determinants of IgG that are potentially reactive
with RF include (1) subclass-specific or genetically defined
determinants of native IgG (IgG 1, IgG 2, IgG 4, and Gm determinants);
(2) determinants present on complexed IgG but absent
on native IgG; and (3) determinants exposed after enzymatic
cleavage of IgG. The Gm determinants are allotypic markers
of the human IgG subclasses located in the IgG molecule as
follows: in the C H1 domain in IgG 1, in the C H2 domain in IgG 2,
and in C H2 and C H3 domains in IgG 4. Although rheumatoid
factor titers may not be clearly correlated with disease activity,
they may help perpetuate chronic inflammatory synovitis.
When IgM rheumatoid factors and IgG target molecules react
to form immune complexes, complement is activated, leading to
inflammation and immune injury. IgG rheumatoid factors may
self associate to form IgG–IgG immune complexes that help
perpetuate chronic synovitis and vasculitis. IgG RFs synthesized
by plasma cells in the rheumatoid synovia fix complement
and perpetuate inflammation. IgG RFs have been shown in
microbial infections, B lymphocyte proliferative disorders and
malignancies, non-RA patients, and aging individuals. RFs
may have a physiologic role in removal of immune complexes
from the circulation. They were demonstrated earlier by the
Rose–Waaler test and are now detected by the latex agglutination
(or RA) test employing latex particles coated with IgG.
Inflammatory
infiltrate
Fibrous
tissue
Rheumatoid nodule.
Necrosis
Palisading
epithelioid cells
rheumatoid nodule
A granulomatous lesion characterized by central necrosis
encircled by a palisade of mononuclear cells and an exterior
mantle of lymphocytic infiltrate. The lesions occur as
subcutaneous nodules, especially at pressure points such as
the elbows in individuals with rheumatoid arthritis or other
rheumatoid diseases.
rheumatoid pneumonitis
Diffuse interstitial pulmonary fibrosis that causes varying
degrees of pulmonary impairment in 2% of patients with
rheumatoid arthritis (RA). It may result from the rare coincidental
occurrence of rheumatoid arthritis and interstitial pneumonia.
Gold therapy used for RA, smoking, and contact with
an environmental toxin may induce interstitial pneumonia.
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