Rheumatoid Arthritis Research Paper

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2-1-1 .The Synovium in Rheumatoid Arthritis : Normally the synovium in any joint consists of 2 cell layers . In RA , there is a process of proliferation of the synovium which might be formed of 10 layers . These layers contain both type A and type B synoviocytes , with mononuclear infiltrates in the lining together with inflammatory cytokines and protease enzymes . Those have a pivotal role in destruction of the bones and cartilages . Those layers will form villous projections into the joint space called ( pannus ) which ultimately invades into the bones and cartilage causing further destructions . 2-1-2 The Synovial Fluid in Rheumatoid Arthritis : The joint space contain small amount of synovial fluid which facilitate joint motion . The…show more content…
It is mostly formed of Ig M antibodies . However , other immunoglobulines were also noted like Ig G and Ig A . Theses RF could also present in normal population . It is estimated that it present 10 – 15 % of normal population . This figure climbs up to 25 % for people who are more than 65 years old . Also these autoantibodies may raise during viral or bacterial infection , malignancy and other autoimmune diseases . Hence , it is not the mild transient elevated values that is important , rather the presence of persistently high titer of these antibodies . For instance , persistently elevated of Ig M RF in high titers , has a sensitivity of 70 % and 80 % specific . RF can present in the sera of patients for up to several years before the disease manifest itself ( 13 , 14 1-3 ) . The cutoff value for the RF is 15 – 20 IU / ml . Several studies have shown that values more than 40 – 50 to be quite specific for RA . ( 6- 10 ) . Ig A RF consider to be more specific than Ig M and Ig G ( 4, 11-13) . Also Ig M RF and Ig A RF are consider as prognostic factors as they are linked to sever diseases with poor outcome , extra articular features and bone erosion . ( 9 , 12 , 14,16) As B cells secrete the RF , this gave the concept of B cell depletion treatment by biologic agent Rituximab
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