3.4.1 & 3.4.2 Rheumatoid Arthritis Flashcards
Can osteoarthritis be catagorized as inflammatory or non-inflammatory arthritis?
Non-inflammatory
Can RA be characterized as inflammatory or non-inflammatory arthritis?
Inflammatory
What area of the hand will be affected by osteoarthritis but not RA?
Distal interphalangeal joints (DIPs)
How long will it take a patient with RA to relieve their morning stiffness as opposed to a patient with osteoarthritis?
RA is usually greater than an hour and osteoarthritis is less, much less
What is this an image of?
Really shitty RA
Answer
Osteoarthritis - morning stiffness is relatively short, DIPs are involved, bony appearing changes
What are the three extraarticular manifestations associated with Felty’s syndrome?
Splenomegaly, leukopenia, and RA
What is the important allele associated with RA?
HLA-DRB1 locus - involved in MHC presentation
What are some environmental risk factors associated with RA?
Caplan’s syndrome, Smoking, Periodontal disease, and changes in the gut microbiome
Who are the important player in the adaptive immune system involvement in RA?
TH17, B cells and their autoantibodies
Who is the key mediator in the innate immune system involvement in RA?
Macrophages - activate downstream cells
When looking at this image what is the important area?
The circled cells should not be there
What is synovitis?
inflammation in the synovial cells
What cells are responsible for the breakdown of the bone in RA?
Osteoclasts
What are the two main test used to assist with diagnosing RA?
RF and CCP
Why is the Rheumatoid Factor iffy?
The sensitivity and specificity are relatively low - possibility of false positives
Sensitivity 70-80%
Specificity 70%
Why is the Anti-cyclic citrullinated peptide test slightly improved over RF?
The specificity is slightly higher at 95% - there will be much fewer false positives
Why is smoking put people at an increased risk for RA?
Smoking promotes PAD enzymes and citrullination in the lungs
What is the difference between seropositive and seronegative RA?
Some individuals are negative for both RF and CCP - they are referred to as seronegative. These have a better clinical outcome
What is important to note about this?
The washed out color or the joints and no DIP involvement
Why is the arrow pointing here
This is erosion of the ulnar styloid and it is a major key to RA
When trying to figure out a diagnosis of RA would you see this in a normal or abnormal patient?
This is not a normal ultrasound image. This patient is more likely to have RA
Match each image with the following:
Early onset RA
Long Term RA
Psoriatic Arthritis
Left to right
Early onset RA
Long Term RA
Psoriatic Arthritis
Is the leukocyte count going to be higher or lower in RA vs osteoarthritis?
In RA it is going to be elevated over 2000 vs osteoarthritis it is going to be lower than 2000
What is the main workhorse drug in regards to RA?
METHOTREXATE - at much lower doses than chemotherapy
How does leflunomide (Arava) work?
Inhibiting pyrimidine synthesis leading to reduction of lymphocytes.
How does hydroxychloroquine (Plaquenil) work?
It inhibits activity of TLRs and inhibits acidification of lysosomes.
How does Azathioprine (Imuran) work?
Purine syntheseis inhibitor - side effect cytopenia and pancreatitis
What is another big category of RA treatments?
TNF inhibitors
All of these drugs fall under what category?
TNF inhibitors
What does Tocilizumab (Actemra) do?
Monoclonal antibody against IL-6. Reducing joint damage and inflammation
What drug seems like it would work for RA but doesnt seem to be terribly effective?
Anakinra (Kineret) - IL-1 antagonist
What does abatacept do?
Binds to CD80/86 on APCs blocking their interaction with APCs
What is Rituximab?
Monoclonal antibody against CD20 - depletes B cells
What is the role of Tofacitinib (Xeljanz)?
It inhibits JAK enzymes
Answer
C - Rituximab - monoclonal antibody against B cells leading to depletion
Answer
C - Diagnose with osteoarthritis and start tylenol. There is DIP involvement and Joint abnormalities bone formation.
What is wrong with this image?
Everything
Does Tanner like football?
Probably, who knows
A man you should never trust is a man who does crossfit.
https://www.instagram.com/p/0VZQ1BOa0Nu2O3pdeeyJ4x9cqlwLkHjWPisps0/?taken-by=msanderson44
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