Early Pathophysiology Of RA Flashcards
What causes RA
Unknown
Possible RA triggers
Infection
Smoking
Obesity
Stress
Female hormones
Pregnancy
Difference between seropositive and seronegative RA
seropositive has anti citrullinated protein antibodies
Seronegative has no ACPAs
Same clinical presentation
Is seropositive or seronegative RA harder to control and which is more common
Seropositive for both
Are smoking, bacterial infections, HLA-DRB1, and PTPN22 risk factors for seropositive or seronegative RA
Seropositive
Are cytomegalovirus, EBV, IRF5, and C type lectins risk factors for seropositive or seronegative RA
Seronegative
Does seropositive or seronegative have higher disease activity, more CV complications, more joint destruction, and higher death rate
Seropositive
What process by neutrophils is involved in RA
NETosis
NETosis
Neutrophils release NETs - lattice of NET fibres containing enzymes, anti microbial peptides, and ion chelations to kill microorganisms
Suicidal NETosis
NETosis where the cell is ruptured and killed to release the NET
Which enzyme citrullinates arginine to citroline
Protein arginine deaminase 4 PAD4
What can cause neutrophils to undergo NETosis in RA when no bacteria are present
Autoantibodies
Rheumatoid factor
IgM to Fc portion of IgG
What processes require PAD4 mediated citrullination of histones
NET formation
Bacterial clearance
Carbamylation
Converts lysine into homocitrullines by reaction with cyanate
How does inflammation and damage from smoking affect anti-CarP antibodies
Incr production of cyanates
Which 3 autoantibodies make up triple positivity and is almost exclusive in RA
Rheumatoid factor
Anti citrullinated protein antibodies ACPA
Anti carbamylated protein antibodies A-CarP
Which 2 chemical processes are involved in RA progression
Citrullination
Carbamylation
What can number of anti modified protein antibodies AMPAs in a RA pts serum predict
Severity of disease
Chance of relapse
Anchor drug treatment for all RA pts
Methotrexate
Is a higher methotrexate starting dose needed to get remission in a seronegative or seropositive RA pt
Seropositive
Seronegative RA treatment
Methotrexate
What causes inflammation in RA
activation of T cells, B cells, and macrophages which release cytokines causing joint damage
Effects of inflammatory cytokines leaking into the bloodstream in RA pts
Systemic inflammation
Anaemia
Thrombocytes is
Fatigue
Osteoporosis
Acute phase response
Systemic RA signs and symptoms
Fever
Weight loss
Muscle fatigue
Haematological and vascular RA signs and symptoms
Anaemia
Thrombocytosis
Eosinophilia
Digital arthritis
Ulcers
Pyoderma gangrenosum
Muscoluskeletal RA signs and symptoms
Muscle wasting
TenoSynovitis
Bursitis
Osteoporosis
Ocular RA signs and symptoms
Episcleritis / scleritis
Scleromalacia
Keratoconjunctivitis sicca
RA cardiac signs and symptoms
Pericarditis
Myocarditis
Endocarditis
Conduction defects
Coronary vasculitis
Granulomatous aortitis
What type of anaemia is anaemia of chronic disease
Normochromic and Normocytic
Progress to Hypochromic then Microcytic
Rheumatoid nodules
Firm non tender subcutaneous lumps usually forming around joints subjected to pressure/trauma
