Lecture 14-ARTHRITIS-THE PATHOLOGY- 13 October 2010

Arthritis is one of the rheumatic diseases

Pathology

Diet and Pathology

Nutraceuticals/functional foods and pathology

TODAY-

Definition of rheumatic diseases

Classification of rheumatic diseases

Focus on rheumatoid arthritis (RA)

Define rheumatoid arthritis

Characteristics of RA

A) causes

B) who is more/less at risk

susceptibility to disease

C) when does the disease occur

D) why does the disease occur

E) what happens to people with the disease

F) diagnosis

G) inflammatory aspects

prostaglandins

leukotrienes

cytokines (TNF-a)

rheumatoid factor

H) treatment

nutrition

diet

functional foods

nutraceuticals

Rheumatic diseases

Disorders of connective tissue, especially the joints and related structures, characterised by inflammation, degeneration, or metabolic derangement.

CLASSIFICATION OF RHEUMATIC DISEASES

I diffuse diseases of the connective tissue

II rheumatoid arthritis

III osteoarthritis

IV spine disorders

V arthropathy

VI internal derangement of the knee

VII joint disorders

VIII symptoms involving the skin

IX tendonitis and bursitis

X disorders of the synovium, tendon and bursa

XI disorders of the muscle, ligament and fascia

XII disorders of the soft tissue

XIII crystal arthropathies (eg gouty arthritis)

XIV disorders of plasma protein metabolism

XV other inflammatory diseases (e.g. psoriatic arthritis)

FOCUS ON RHEUMATOID ARTHRITIS (RA)

DEFINE RA

Chronic inflammatory disease in which there is destruction of joints. Considered by some to be an autoimmune disorder in which immune complexes are formed in joints and excite an inflammatory response that leads to the destruction of the synovial lining.

CHARACTERISTICS OF RA

Causes

angiogenesis

autoimmune disorders

inflammation

cytokines

Can affect any joint but typically affects small joints of the hands and feet

Chronic inflammation starting in synovial membrane and ending in joint cartilage

WHO IS MORE/LESS AT RISK IN TERMS OF SUSCEPTIBILITY TO DISEASE

MORE LESS

NATIVE AMERICAN RURAL AFRICAN,

(PIMA, CHIPPEWA, YAKIMA) CHINESE

INDONESIAN

WHEN DOES THE DISEASE START

INCIDENCE

PER 100,000

AGES OF ONSET MALES FEMALES

0-14 YEARS 6 12

15-24 YEARS 6 15

25-44 YEARS 12 26

45-64 YEARS 23 46

65-74 YEARS 25 50

75+ YEARS 32 49

HOW WIDESPREAD IS THE DISEASE

PREVALENCE

PER 100,000

AGES OF ONSET MALES FEMALES

0-14 YEARS 0 3

15-24 YEARS 100 200

25-44 YEARS 200 625

45-64 YEARS 1100 2025

65-74 YEARS 2000 3750

75+ YEARS 2500 4700

RISK-women

-nulliparity

-breast feeding

-reduction of risk in women-use of oral contraceptives

WHAT HAPPENS TO PEOPLE WITH THE DISEASE

Loss of mobility

Loss of productivity due to pain and loss of mobility

DIAGNOSIS

Clinical symptoms

-pain

-stiffness

-swelling of joints

laboratory indicators

-eicosanoids, cytokines, tissue necrosis factor, rheumatoid factor

INFLAMMATION AND ITS REGULATION ASPECTS

eicosanoids- prostaglandins and leukotrienes

cytokines

tissue necrosis factor

rheumatoid factor

EICOSANOIDS

PRO-INFLAMMATORY ANTI-INFLAMMATORY

PGE1 X

PGE2 X X

PGI2 X X

LTA4 X

LTC4 X

LTD4 X

LTE4 X

CYTOKINES (POLYPEPTIDES)

PRO-INFLAMMATORY ANTI-INFLAMMATORY

IL-1 X

IL-2 X

IL-4 X

IL-6 X

IL-8 X

TNF-a X

RHEUMATOID FACTOR

Complex of IgG and anti-IgG formed in joints in rheumatoid arthritis. Serum rheumatoid factors are more usually formed from IgM antibodies directed against IgG.

Produced in response to inflammation

TREATMENT

Anti-inflammatory medications

-steroidal drugs inhibit cyclooxygenase

-cause water retention

-non-steroidal drugs (NSAIDs) (eg aspirin)-inhibit cyclooxygenase

-cause ulcers in some -cause ulcers in some people