BL- RA Flashcards
secondary causes of hyperuricemia in normal uric acid metabolism
a
RHEUMATOID ARTHRITIS
Articular manifestations
Joint distribution 1
Predominantly peripheral synovial joints in a symmetric pattern, particularly the small joints of the hands and feet, although medium and large joints are also involved.
DIP often spared.
Rheumatoid arthritis (RA) is a systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a peripheral, symmetric, inflammatory synovitis often leading to:
cartilage and bone destruction and joint deformities
RHEUMATOID ARTHRITIS
Articular manifestations
Joint distribution 2
Cervical spine also commonly involved (usually C1-2)
Other synovial joints may be involved including the cricoarytenoid, ossicles of inner ear, and temporomandibular joint.
Rheumatoid arthritis (RA) is a ______________ disorder of unknown etiology that results predominantly in a peripheral, symmetric, inflammatory synovitis often leading to cartilage and bone destruction and joint deformities
systemic, inflammatory, autoimmune
Joint spared in RA?
DIPs
RHEUMATOID ARTHRITIS
Articular manifestations
Symptoms
Morning stiffness, soft tissue swelling around joints, and pain.
Deformities and loss of function possible.
Rheumatoid arthritis (RA) is a systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a __________ often leading to cartilage and bone destruction and joint deformities
peripheral, symmetric, inflammatory synovitis
RHEUMATOID ARTHRITIS
Articular manifestations
Signs
Joint warmth and swelling
Tenderness to palpation with limitation of motion.
Possible deformities may be present.
Serologic findings RA Rheumatoid factor (RF) is present in \_\_\_\_\_\_.
85%
Serologic findings RA
_______proteins often elevated.
ESR or C-reactive
Anemia and ______are frequently found in RA
hypergammaglobulinemia
Anti-cyclic citrullinated peptide (CCP) antibodies present in ______: Anti-CCP antibodies are highly specific (specificity > 90%) for RA.
70%
______ and hypergammaglobulinemia are frequently found in RA
Anemia
Anti-cyclic citrullinated peptide (CCP) antibodies present in 70%: Anti-CCP antibodies are highly_______
specific (specificity > 90%) for RA.
Synovial fluid analysis RA
Inflammatory (>2000 WBC/microliter) with predominantly neutrophils.
Complement and glucose levels usually low.
Radiographic findings RA
Soft tissue swelling.
Juxta-articular osteopenia.
Symmetric loss of joint space.
Erosions in marginal distribution.
Rheumatoid nodules
Present in 20-25%, associated with presence of serum RF.
Location: extensor surfaces and tendon sheaths.
May be present in a variety of internal organs, particularly lung.
Rheumatoid arthritis is a common disease with characteristic articular and extra-articular clinical manifestations, and helpful:
X-ray and laboratory findings.
This is a polygenic disease with different sets of genes being involved in different population groups.
Specific _________ appear to predispose both to acquiring the disease and to developing greater degrees of severity of joint tissue destruction.
HLA-DR molecules
The pathology is an inflammatory synovitis with fibroblasts, macrophages, mast cells, T cells, B cells, plasma cells and dendritic cells in the synovium all involved, as well as ___________
chondrocytes in the articular cartilage
The pathology is an inflammatory synovitis with fibroblasts, macrophages, mast cells, T cells, B cells, plasma cells and dendritic cells in the ______ all involved, as well as chondrocytes in the articular cartilage
synovium
The pathology is an inflammatory synovitis with _______ cells in the synovium all involved, as well as chondrocytes in the articular cartilage
fibroblasts macrophages mast cells T cells B cells plasma cells dendritic
CD4+ T cells in the synovium may be important in initiation and maintenance of the disease process through recognition of arthritogenic peptides. B cells also are important both through production of _______ and sustaining T cell function.
autoantibodies
The destruction of articular cartilage and marginal bone is carried out by neutral proteinases released by proliferating fibroblasts in the synovium, called pannus, and by chondrocytes in the articular cartilage under the influence of IL-1 and TNF-alpha primarily derived from synovial _____.
macrophages
CD4+ T cells in the synovium may be important in the disease process through recognition of _______. B cells also are important both through production of autoantibodies and sustaining T cell function.
arthritogenic peptides
The destruction of articular cartilage and marginal bone is carried out by neutral proteinases released by proliferating fibroblasts in the synovium, called pannus, and by chondrocytes in the articular cartilage under the influence of _______ primarily derived from synovial macs
IL-1 and TNF-alpha
______cells in the synovium may be important in initiation and maintenance of the disease process through recognition of arthritogenic peptides. B cells also are important both through production of autoantibodies and sustaining T cell function.
CD4+ T
The destruction of articular cartilage and marginal bone is carried out by neutral proteinases released by proliferating _______, called pannus, and by chondrocytes in the articular cartilage under the influence of IL-1 and TNF-alpha primarily derived from synovial macs. (RA)
fibroblasts in the synovium
IL-1, TNF-alpha, and IL-17 also play a role in osteoclast formation. Neutrophils in the synovial fluid also may contribute to_______. (RA)
tissue destruction
Synovial macrophages stimulated by T cells, or both macrophages and fibroblasts in chronic rheumatoid synovitis may function in an autonomous and _______. (RA)
self-perpetuating fashion
IL-1, TNF-alpha, and IL-17 also play a role in osteoclast formation. _______also may contribute to tissue destruction. (RA)
Neutrophils in the synovial fluid
________, or both macrophages and fibroblasts in chronic rheumatoid synovitis may function in an autonomous and self-perpetuating fashion. (RA)
Synovial macrophages stimulated by T cells
_______also play a role in osteoclast formation. Neutrophils in the synovial fluid also may contribute to tissue destruction. (RA)
IL-1, TNF-alpha, and IL-17
Treatment as Related to Pathophysiology (RA)
Anti-inflammatory/analgesic drugs
relieve patient symptoms, but these do not prevent tissue destruction.
The mechanisms of action include inhibition of production of inflammatory mediators.
Treatment as Related to Pathophysiology (RA)
Disease-modifying anti-rheumatic drugs (DMARDs)
primarily inhibit various macrophage and lymphocyte functions.
Newer therapeutic agents include biologic agents that inhibit the effects of cytokines, particularly IL-1 , TNFalpha and IL-6 (tocilizumab);
inhibit a T cell costimulator molecule and modulate T cell activation or deplete B cells (rituximab).
Treatment as Related to Pathophysiology (RA)
“other” options
PT
Surgery
primarily inhibit various macrophage and lymphocyte functions.
Newer therapeutic agents include biologic agents that inhibit the effects of cytokines, particularly IL-1 , TNFalpha and IL-6 (tocilizumab);
inhibit a T cell costimulator molecule and modulate T cell activation or deplete B cells (rituximab).
DMARDs
_____________are instituted early after diagnosis in an effort to prevent tissue destruction. These medications include hydroxychloroquine, sulfasalazine, leflunomide, or methotrexate.
Disease-modifying anti-rheumatic drugs (DMARDs)
Rheumatoid factors (RF) are immunoglobulins that recognize epitopes present within the _____.
Fc portion of IgG
lead to complement activation via the classical pathway, producing inflammatory consequences
Lumbosacral spine - both sacroiliac joint spaces are completely obliterated. There is also obliteration of the posterior elements in the distal lumbar area and bridging or “bambooing of the spine”. Chest x-ray - “squaring-off of the mid-portion of the thoracic vertebrae but no significant syndesmophyte formation.
Diagnosis? (it’s not RA)
Ankylosing spondylitis
The enthesis is the_______between tendon or ligament and bone.
connective tissue
Related to AS
What percent of AS has peripheral arthritis?
25%
100% in RA has peripheral involvement
Spine involvement in RA?
C spine
C1/C2
very severe poorly treated RA
spondyloarthropathy diseases that are bilateral?
AS and colitis
