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We’re continuing the Daily Morning Quiz ☕️ (previously PhysioPulse Premium) and have extended their subscriptions by 3 months as compensation! 🎉

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The free Weekly Morning Quiz ☕️ will also continue as usual.

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Morning Quiz ☕️ 

A 54-year-old woman presents with pain in both hands and wrists that has been ongoing for several years. She reports that the pain is associated with morning stiffness lasting nearly an hour.

On physical examination, there is tenderness and swelling in both hands and wrists, most prominently over the proximal interphalangeal joints (PIPs).

Laboratory investigations reveal the presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Which of the following immune-mediated processes is most likely responsible for this patient’s condition?

A. Loss of self-tolerance
B. Both type II and type III hypersensitivity
C. IgE-mediated immune responses only
D. Type III hypersensitivity

Correct Answer 🎯: D. Type III hypersensitivity

 Immune Complex "Landmines" = RA’s core pathology
Type II (B) = No cell lysis (e.g., no hemolysis)
IgE (C) = No allergies/anaphylaxis
Self-tolerance (A) = Only the start, not the main attack

⚙️

 Genetic Susceptibility (e.g., HLA-DR4) + Environmental Trigger (e.g., Smoking, Infection)
⬇
⚡ Immune System "Misfire"

(Like a security guard attacking citizens instead of invaders!)

⬇

Loss of Self-Tolerance 

⬇

Autoantibody Production (RF, Anti-CCP)

B-cells make "fake warrants" (Anti-CCP) → Mark healthy joint proteins as enemies
⬇
Immune Complex Formation (IgG + Anti-CCP/Anti-IgG)

⬇
Deposition in Synovial Membranes (Joints, PIPs, Wrists)

⚙ Joint Invasion: The "Silent Bomb" Mechanism
⬇
Complement Activation (C3a, C5a) + Fc Receptor Engagement
⬇
Neutrophil/Macrophage Recruitment "bomb squad" arrive

⬇

Phagocytosis Attempt
⬇
Inflammatory Cytokine Release (TNF-α, IL-1, IL-6 ↑)

"firestorm" release

(Like firefighters accidentally spraying gasoline!)
⬇
Synovial Fibroblast Activation → Pannus Formation
⬇
Cartilage/Bone Destruction (Erosion via MMPs, Osteoclasts)

🔥 Synovial "wildfire" (Pannus)
⬇
Clinical Manifestations:

• Pain + Swelling (PIPs, wrists) → Synovitis + Edema

• Morning Stiffness (>1 hr) → Overnight Cytokine Accumulation

• Anti-CCP+ → Highly Specific for RA (Type III Hypersensitivity)

Symptoms Explained 🔧

Differential Table ⚖️

Practice Questions ⏳️ 

Your Brother in This Struggle

Dr. Shoaib Ahmad