Multiple choice

RA is a disease of joint destruction; which of the following scenarios is most pertinent to the immunopathogenesis?

  1. Macrophage activation by rheumatoid factor.

  2. The triggering factor is Campylobacter jejuni.

  3. CD4 T cells produce TNF-α cytokine that activates macrophages.

  4. The acute phase response that accompanies active RA disease suggests that persistent infection is a factor.

  5. MHC association with HLA B27 is important in Europeans and RA is restricted to this group of individuals.
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C Correct answer
Explanation

In RA, CD4 T cells produce cytokines including Tumour Necrosis Factor [TNF], which activates macrophages to produce tissue destroying enzymes and remodelling cytokines which deform the affected joints. Anti-TNF therapies provide potent therapies for many but not all patients with RA.

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