Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IBI Test 2 > B3.023 Rheumatoid Arthritis > Flashcards

B3.023 Rheumatoid Arthritis Flashcards

1
Q

non inflammatory arthritis

A

osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

types of inflammatory arthritis

A

rheumatoid
psoriatic
Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

definition of osteoarthritis

A

mechanical derangement of joint

“wear and tear”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cause of primary osteoarthritis

A

aging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

causes of secondary osteoarthritis

A

trauma

genetic conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

most common places of osteoarthritis involvement

A

knee
hip
hands (PIPs, DIPs, MCPs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

rheumatoid arthritis epidemiology

A

prevalence approx. 1%
-lower in Africa, higher in native americans
women 2-3x more likely than men
peak onset 50-75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the clinical presentation of RA

A

symmetric polyarticular involvement
upper and lower extremities
can affect most joints but spares DIPs
most common joints involved first include MCPs, PIPs, wrists, and MTPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

distinguish between morning stiffness associated with RA and OA

A

RA usually > 1 hour

OA 30 min or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do swollen joints feel early in RA?

A

fluid filled and boggy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are some classic joint changes associated with late stages of RA?

A 
ulnar deviation at MCPs in setting of subluxation
Z deformity
swan neck (extension of PIP and flexion of DIP)
boutonniere deformity (flexion of PIP and extension of DIP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are some clues to distinguish OA?

A 
associated with activity
short morning stiffness
DIPs affected
bony appearing changes
no ulnar deviation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which type of arthritis is associated with extraarticular manifestations

A

RA is a systemic inflammatory disease not limited to just the joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

pulmonary extraarticular manifestation

A 
pleural disease (effusions and pleurisy)
pulmonary nodules
interstitial lung disease (extensive honeycombing on CT due to scarring and destruction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cardiac extraarticular manifestation

A

pericarditis and pericardial effusion (similar to lupus)
nodules (can affect conduction and valves)
myocarditis
accelerated CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

skin extraarticular manifestations

A 
rheumatoid nodule
rheumatoid vasculitis (inflammation of blood vessels leads to occlusion and ischemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

eye extraarticular manifestations

A

secondary Sjogren’s/Keratoconjunctivits sicca (inflammation of salivary glands, dryness of eyes and mouth)
episcleritis and scleritis
corneal melt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hematological extraarticular manifestations

A

Felty’s syndrome - splenomegaly, leukopenia, and RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are some nonspecific changes the body may undergo related to inflammation in RA?

A

anemia of chronic disease
thrombocytosis
leukocytosis

20
Q

neurologic extraarticular manifestations

A 
entrapment neuropathy (carpal tunnel syndrome, due to swelling)
spinal cord compression related to spine involvement such as C1-C2 (can lead to paralysis)
21
Q

discuss the genetic findings of twin studies related to RA

A

monozygotic: 15-30%
dizygotic: 5%
general population: 1%

22
Q

what is the shared epitope of RA?

A

highly similar AA sequence in alleles in HLA-DRB1 locus

strongest genetic link to RA

23
Q

what is HLA-DRB1 involved in?

A

MHC molecule-based antigen presentation
self peptide selection
T-cell repertoire

24
Q

what are some environmental factors that may contribute to RA?

A

silica (caplan’s syndrome)
smoking
periodontal disease
gut microbiome

25
Q

which type of Th cell is an important link with the innate immune system?

A

Th17

26
Q

how are autoantibodies related to the innate immune system?

A

can activate macrophages

27
Q

which type of leukocyte activate downstream cells that mediate damage seen clinically in RA?

A

macrophages

28
Q

how does RA appear on an H&E stain?

A

fibrovascular tissue protrudes from inflamed synovium into the articular cartilage

29
Q

what is the roles of osteoclasts in RA?

A

ultimately lead to bone destruction resulting in erosions and joint deformities

30
Q

which lab tests assist with diagnosis of RA?

A

rheumatoid factor (RF)
anti-cyclic citrullinated peptide (CCP)
anti-nuclear antibody (ANA)

31
Q

which lab tests assist with monitoring RA disease activity?

A

erythrocyte sedimentation rate (ESR)

c-reactive protein (CRP)

32
Q

which lab tests assist with medication monitoring in RA?

A

CBC with dif
creatinine
AST, ALT

33
Q

rheumatoid factor

A

autoantibodies that recognize determinants of the Fc portion of IgG
most commonly IgM against Fc portion of IgG
sens: 70-80%
spec: 70% (increases w age and associated with other diseases)

34
Q

anti-cyclic citrullinated peptide (CCP)

A

post translational modification to arginine performed by antibody peptidylarginine deiminase (PAD) to form citrulline

sense: 70%
spec: 95%

35
Q

why is citrullination an issue?

A

citrullinated proteins fit with the HLA-DRB1 epitope on APCs, stimulating antibody production
if you then get citrullinated proteins in your joints, they complex with the Abs stimulating complement activation/ an inflammatory response

36
Q

how is smoking thought to be related to RA?

A

smoking promotes PAD enzymes and citrullination in the lungs

37
Q

what is seronegative RA?

A

people with RA who test negative for both RF and CCP

20% of patients

38
Q

seropositive RA

A

associated with worse prognosis

39
Q

what about positive RF and CCP but no RA?

A

patients could be early in disease development or may not develop disease at all

40
Q

synovial fluid findings in RA

A

inflammatory synovial fluid cell count

5000-50000 cells w predomninant neutrophils

41
Q

radiographic findings in RA

A 
periarticular osteopenia (bones near joints get darkers)
symmetric joint space loss
marginal erosions
soft tissue swelling
no new bone formation
42
Q

is MRI commonly used to diagnose RA?

A

no, not usually worth additional cost to see minimally different images

43
Q

ultrasound findings of RA

A

high power Doppler signal consistent with active disease

gray scale synovial hypertrophy

44
Q

when do you use ultrasound in RA patients?

A

prognosis more than for diagnosis

45
Q

radiographic findings in RA versus OA

A

RA: erosions, periostitis, joint space narrowing
OA: joint space narrowing, osteophytes, subchondral sclerosis

IBI Test 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions