1) Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis?

Answer 1

Chronic, inflammatory disease mediated by the immune system that affects peripheral joints symmetrically, with the possibility of becoming a systemic disease.

Question 2

Who does rheumatoid arthritis affect?

Answer 2

1 in 100 Canadians affected.

Affects women compared to men 3:1

Question 3

Name 4 causes of RA.

Answer 3

1. Genetics
2. Smoking
3. Infections
4. Autoimmunity

Question 4

What is a synovial membrane?

Answer 4

Thin layer of connective tissue between joint capsule and synovial cavity.

Question 5

What is synovial fluid?

Answer 5

An ultra-filtrate of blood that diffuses across the synovial membrane and into the joint cavity composed of hyaluronan and lubrican

Question 6

What is hyaluronan and lubrican?

Answer 6

Hyaluronan regulates cartilage viscosity and lubrican lubricates cartilage.

Question 7

What is a joint composed of?

Answer 7

A normal synovium is composed of the synovial lining with an interstitium lying below with blood vessels but few cells.
It contains fibronectin which holds the collagen together and synoviocytes on the inner capsule that create synovial fluid

Question 8

Signs of RA on the synovial membrane.

Answer 8

Pannus Formation (growth of fibrous tissue on the joint) causes the loss of bone and causes cartilage formation
Activation of the inflammatory immune cells in synovial fluid

Question 9

The 4 cells activated in immune response of RA

Answer 9

• Fibroblast -like synoviocytes
• Macrophage-like synoviocytes
• Macrophages
• T cells and B cells

Question 10

How do mediators of inflammation enter the joint?

Answer 10

Mediators of inflammation enter the joint via the ultra- filtrate of blood that diffuses across the synovial membrane

Question 11

What do osteoclasts do?

Answer 11

Break down bone (bone resorption)

Stimulates immune response

Question 12

What is pannus formation caused by?

Answer 12

It is caused by fibroblasts which are activated by the immune response.

Question 13

What percent of lymphocytes are TCells in RA synovium?

Answer 13

30- 50%

Question 14

What occurs with the activation of TCells in the RA synovium?

Answer 14

• Production of prostaglandins, cytotoxins, and cytokines
• Release of inflammatory cytokines, matrix
metalloproteinases (degrade bone
matrix), osteoclasts, and B cells

Question 15

What is IL-6?

Answer 15

It is the most abundant pro-inflammatory cytokine in the synovium and it stimulates the synthesis of acute-phase reactants from the liver, osteoclasts, T-lymphocytes, B lymphocytes

Question 16

What are the 3 ways that B cells are thought to affect RA

Answer 16

1. Produce auto-antibodies
2. Stimulate cytotoxin and free radical release (RF, anti-CPP and ANA)
3. Activate T cells

Question 17

What do the auto antibodies RF, anti-CCP and ANA do?

Answer 17

They damage synovium and bone. Antibodies are involved in the phagocytosis of the cartilage and bone creating more inflammation of the joints

Question 18

Name the three pro-inflammatory cytokines

Answer 18

IL-1, IL-6, TNF alpha

Question 19

What are the four major symptoms of RA?

Answer 19

Symptoms progress over months
Pain and stiffness begin in 1 to 2 joints and progress to poly-articulate presentation
Pain persists for over an hour after waking
Systemic complaints can develop

Question 20

What are the main clinical symptoms of RA?

Answer 20

Small joint stiffness that is typically worse in the morning. Inflammation is also associated with RA which results in muscle atrophy, weakness and deformity

Question 21

Rheumatoid arthritis is the leading cause of disability in Canada.
True or False

Answer 21

True

Question 22

Name the 6 lab tests that can be done (specific and nonspecific) that can be done to diagnose RA.

Answer 22

RF, anti-CPP, ESR, CRP, ANA and Fe

Question 23

What is the most specific test for RA?

Answer 23

Anti-CPP, May be detected up to 15 years before onset of clinical symptoms of RA ***

Question 24

Name two other diagnostic tests for RA.

Answer 24

Increased white blood cell count within joint fluid.

Joint space narrowing

Question 25

What are the 5 systemic affects of RA?

Answer 25

Rheumatoid nodules
Cardiopulmonary disease
Eye disease
Sjogren’s Syndrome (Dry Eyes and Dry Mouth)
Rheumatoid vasculitis

Question 26

They are painless, fibrous cells that surround necrotic tissue on the arm and can also affect the lungs, heart and eyes

Answer 26

Rheumatoid nodules

Question 27

The medical term for the eye disease that occurs with RA

Answer 27

Episcleritis

Question 28

Majority of patients have a cyclic type of disease with RA meaning:

Answer 28

There are flares followed by periods of remission

Question 29

What are the 5 nonpharmalogical treatments for RA?

Answer 29

Rest
Occupational/ Physical therapy
Assistive devices
Weight loss
Surgery

Question 30

The 3 major treatment classes in a pharmacological perspective are

Answer 30

NSAIDs
Corticosteroids
DMARDs

Question 31

What are Disease-modifying anti-rheumatic

drugs (DMARDS)?

Answer 31

They are agents that modify course of disease and improve prognosis; include non-biologic and biologic agents.
Suppress cellular and humoral immune system responses

Question 32

NSAIDA and Corticosteroids are considered what as far as treatment?

Answer 32

Symptomatic management