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CLS 1113 Introduction to Clinical Laboratory Practices

CLS 1113 Introduction to Clinical Laboratory Practices. Unit 6 Chapter 12. Rheumatoid Arthritis. Similarities to SLE Systemic Age 20-40 Women Mortality Men usually die 4 years earlier than usual Women die 10 years earlier than normal.

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CLS 1113 Introduction to Clinical Laboratory Practices

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  1. CLS 1113Introduction to Clinical Laboratory Practices Unit 6 Chapter 12

  2. Rheumatoid Arthritis • Similarities to SLE • Systemic • Age 20-40 • Women • Mortality • Men usually die 4 years earlier than usual • Women die 10 years earlier than normal.

  3. Criteria for the Classification of Rheumatoid Arthritis • Morning Stiffness • Arthritis of 3 or more joint areas • Arthritis of hand joints

  4. Criteria for the Classification of Rheumatoid Arthritis • Symmetric arthritis • Serum rheumatoid factor • Radiographic changes

  5. Progression • Begins with nonspecific symptoms: • Malaise, fever, weight loss, and joint pain • Progresses from small joints to large joints in a symmetric fashion

  6. Progression • Joint pain leads to muscle spasm • Joint deformity • Nodules over the bones (25%) • Necrotic areas surrounded by mononuclear cells with an outer zone of granulation tissue containing plasma cells and lymphocytes.

  7. Progression

  8. Immunology • “Rheumatoid Factor” • This antibody is directed against the Fc portion of IgG. • The antibody is not specific for RA • It is associated with increasing morbidity and amplifies inflammation • Polyclonal activation of B cells may occur resulting in the production of HUGE amounts of anti-IgG antibodies.

  9. Immunology • Other antibodies associated with RA: • ANA, anticollagen antibodies, etc. (page 186) • This collection of Ab’s may result in immune complex formation and activation of Complement • Joint injury is due, in part, by invasion by macrophages and neutrophils • Proliferation of cells that line the synovium…

  10. Treatment • Treatment is palliative. • Aspirin • NSAIDS • Anti-rheumatic drugs are starting to be used but they cause: • Hair loss, cytopenia, nausea, and hepatic toxicity • The newest treatments are: • Monoclonal antibody against specific cells and treatment with cytokines and cytokine inhibitors

  11. Testing • Correlation of lab tests with clinical symptoms • Screening Tests • RF agglutinates Sheep RBCs coated with IgG • Latex agglutination • Quantitative Tests • ELISA • Nephelometry

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