Al-Mehdi Rheumatology Flashcards by Madeline Wing

mechanical wear and tear and damaged cartilage

osteoarthritis

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chronic systemic inflammatory disease of synovial tissues

rheumatoid arthritis

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seronegative (non-RF) and damaged enthesis (tendon to bone)

Anklyosing spondylitis

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seronegative and is acquired sometimes by patients with psoriasis

psoriatic arthritis

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seronegative and comes about after having an infection

reactive arthritis

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gout, lesch-nyhan syndrome, and pseudogout are all what

crystal arthopathies

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autoimmune inflammatory disease of synovial tissues; more prevalent in white females; SMOKING!!!

Rheumatoid arthritis

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HLA associated with RA

DR4, DRB1*0404

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smoking causes what that leads to RA

activation of peptidyl-arginine deiminase (PAD)
(Arginine to Citrulline)

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citrullination of fibrinogen, type II collagen and filaggrin causes what in RA

autoantigen

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2 types of autoantibodies formed in RA

anti-citrullinated and anti-cyclic citrullinated forms

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what happens in RA that deals with plasma cells recognizing what as foreign

plasma cells class switch to IgG and then recognize it as foreign, so then they class switch again to IgM and attack its own product

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type of hypersensitivity that RA is associated with

type III; IgG-IgM immune complex

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where are the immune complexes in RA deposited and cause what

blood vessels and cause vasculitis

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what 2 cells are on the synovial membrane

synovial macrophage
synovial fibroblast

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what synovial membrane cell is activated by IFN-gamma

synovial macrophage

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what synovial membrane cell is activated by IL-17

synovial fibroblast

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MMP, TNF-a, IL-1, IL-6, PGE2, LTB4, and VEGF are all produced by what

the 2 synovial membrane cells

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the products of synovial macrophages and fibroblasts lead to what 3 main things

tissue damage
inflammation
pain and swelling

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what makes a ligand for RANK receptor on osteoclast that leads to bone erosion

synovial fibroblasts

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symmetrical swelling, morning joint stiffness, and mainly deals with wrist

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anti-citrullinated Ab

early IgG

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IgM Ab (RF) against what

IgG

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involves PIP and DIP

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does NOT involve DIP

bilateral PIP joint swelling and difficulty making a fist happens to the hand when

in early RA

what can also happen in RA when median n is compressed

carpal tunnel syndrome

flexion of PIP and hyperextension of DIP

boutonniere finger

flexion of MCP, extension of PIP, and flexion of DIP

swan neck finger

very little pain early on, main symptom is morning stiffness; pannus (thickening of synovial membrane)

98% specificity for ACPA

elevated ESR (means inflammation) and CRP (made by liver and means inflammation), order CBC w/ diff, ANA increased, and synovial fluid more than 2000 PMNs

main diagnostic imaging you will see in RA

pannus

EARLIEST SIGN OF RA

juxta-articular osteopenia

symmetrical loss of joint space

loss of joint space in one compartment

cord compression of C1 and C2 can kill patient who has what

nodules, felty syndrome, secondary sjogren syndrome, and vasculitis are what

extra-articular manifestations in RA

classic location of nodules for RA

olecranon bursa

classic location of vasculitis in RA

palms and fingers

RA + splenomegaly + neutropenia

felty syndrome (severe RA)

DRYNESS (keratoconjunctivitis-dry eyes and xerostomia-dry mouth)

secondary Sjogren syndrome

first line drugs for RA and felty syndrome

methotrexate HCQ glucocorticoids SSZ

drug used for RA that blocks clonal expansion of T cells; Dihydrofolate reductase inhibition!!!!!

methotrexate

drug used to inhibit T cell clonal expansion; inhibits dihydro-orotate dehydrogenase!!!

Leflunomide

only drug you can give a pregnant patient who has RA; blocks TLR-9 (blocks synovial macrophage)

HCQ

used for RA and inhibits gene expression of all cytokines

glucocorticoids

Baricitinib Tofacitinib Upadacitinib (-tinibs)

block JAK/STAT (inhibit gene expression)

used to treat RA and blocks B cells

Rituximab

used to treat RA and blocks PGE2

Celecoxib

first line anti-inflammatory drug for RA

SSZ

blocks IL-1 and used to treat RA

Anakinra

(-umabs) to treat RA Inflixumab Adalimumab Golimumab Certolizumab

block TNF-a

TNFa decoy receptor used to treat RA

Etanercept

drug used to treat RA and blocks RANKL (produced by synovial fibroblast) from binding to RANK on osteoclast

Denosumab

biological drugs end in what

-mab and -cept (monoclonal Ab's and decoy receptors)

what do you have to monitor when patient is on HCQ for RA (hydroxychloroquine)

eye

what do you have to monitor when patient is on SSZ (sulfasalazine) for RA

LFTs, CBC

what do you have to monitor when patient is on methotrexate for RA

LFTs, urine

what do you have to monitor when patient is on Leflunomide for RA (used to inhibit clonal expansion of T cells)

LFT, blood pressure

why you need to put patient on antibiotics for pharyngitis

to prevent acute rheumatic fever

patient has redness, swelling, and tenderness of 1st MTP bilaterally from dancing

bursitis

what are you at risk for developing if you dance a lot and already have bursitis

NO inflammation; happens from wear and tear of joints (obesity can cause this too); destroys cartilage

Osteoarthritis (OA)

function of menisci

keep bone in joint

climbing stairs is a main cause of what

brief morning stiffness, bouchard and heberden nodes, joint pain w/ activity; seronegative; CREPITUS

to diagnose OA

imaging

look at R hip; diagnosis

A, B, C

A: Gout B: RA (ulnar deviation) C: OA

what are you treating for OA

PAIN, not inflammation

celecoxib, duloxetine, tramadol and even steroid injection used to treat what

this deals with osteopenia, while this deals with osteophytes

RA, OA

seronegative, HLA-B27; extrasynovial inflammation (joint fusion)

seronegative spondyloarthritis

pathognomonic for all seronegative spondyloarthritis

conjunctivitis, uveitis, urethritis, arthritis (can't see and can't pee, can't climb a tree)

Ankylosing Spondylitis

How do RA and AS differ in terms of MHC/HLA association?

RA: MHC class II HLA-DRB1 AS: MHC class I HLA-B27

DIP involved, psoriasis, sausage digits (dactylitis)

Psoriatic arthritis

conjunctivitis, uveitis, urethritis, arthritis (can't see and can't pee, can't climb a tree); and had a previous infection (won't see microbe in joint)

Reiter Syndrome

gonoccal monoarthritis will have arthritis from infection but not what

NO ocular symptoms

Chlamydia, Salmonella, Shigella, Campylobacter can cause what

reactive arthritis