PATHOLOGY antigen HLA-DR( QKRAA)、 heat shock protein、IgG、 type Ii col antigen processing macrophages +MHCII-peptide complexes presentaTion T cell cytokine(IL-1、2、3、4、6、TNF、r-INF) B cell activation Immune damage RF and other antibody collagenase, stromelysin cartilage and bone destruction extra-articular symptom
antigen :HLA-DR(QKRAA)、heat shock protein、IgG、type II collagen antigen processing macrophages +MHCII-peptide complexes presentation T cell cytokine（IL-1、2、3、4、 6、TNF、r-INF） B cell activation immune damage RF and other antibody collagenase、stromolysin cartilage and bone destruction extra-articular symptom PATHOLOGY
类风湿性关节炎滑膜病理 PATHOLOGIC FINDING / 1. chronic synovitis In acute phase: effusion and cell infiltration In chronic phase the number of a type cell remarkably increases the pannus erodes cartilage bone ligaments and tendons 2. extra-articular: vasculitis rheumatoid nodule
PATHOLOGIC FINDING 1. chronic synovitis In acute phase: effusion and cell infiltration In chronic phase: the number of A type cell remarkably increases the pannus erodes cartilage, bone, ligaments and tendons. 2. extra-articular：vasculitis、rheumatoid nodule
CLINICAL FAETURES The usually age at onset is 35-50 years y the ratio of female to male is 3 1 Y the onset of ra is usually insidious Y Systemic symptom of fatigue, malaise, fever weight loss may be seen
CLINICAL FAETURES ✓ The usually age at onset is 35-50 years ✓ The ratio of female to male is 3:1 ✓ The onset of RA is usually insidious ✓ Systemic symptom of fatigue, malaise, fever, weight loss may be seen
Joint manifestation (1)morning stiffness stiffness persisting for over 30 minutes is prominent in the morning or after daytime activity and subsides during the day The persisting length of morning stiffness is associated with the degree of joint nflammation The duration of morning stiffness is used as the index of disease activity
1. Joint manifestation （1）morning stiffness – stiffness persisting for over 30 minutes is prominent in the morning or after daytime activity and subsides during the day – The persisting length of morning stiffness is associated with the degree of joint inflammation. – The duration of morning stiffness is used as the index of disease activity
腕关节 (2) pain and tenderness: painful on rest location: small(PIP, MCP), symmetric joint 掌指关节 characteristic: persisting dull or swollen pain 指间关节 (3)swelling: synovial proliferation, effusion, swelling of soft tissue (4)articular deformity: ulnar deviation of the angers, "swan-neck deformity, atrophy of skin and muscle(see figurel-5 (5) involvement of special joint: atlantoaxial subluxation, shoulders, temporomandibular joint, hips
（2）pain and tenderness： painful on rest location：small (PIP,MCP), symmetric joint characteristic：persisting、dull or swollen pain （3）swelling：synovial proliferation, effusion, swelling of soft tissue （4）articular deformity：ulnar deviation of the fingers, “swan-neck” deformity, atrophy of skin and muscle (see figure1-5) （5）involvement of special joint: atlantoaxial subluxation，shoulders, temporomandibular joint, hips