L7:pathophysiology of joint disease Flashcards
RF=
rheumatoid factor
CCP=
cyclic citrullinated peptide
joints affected by RA
MCPs
MTPs
wrists
5 key features of RA
- Chronic
- symmetrical
- inflammatory
- deformity
- polyarthritis
primary site of pathology in RA
synovium
synovitis=
inflammation of the synovial cells
first cell to be triggered in RA
T-cells
what do triggered T cells in RA do
stimulate macrophage, fibroblast and B-cell activity
most important cytokines in RA
TNF-alpha
IL-1
what do fibroblasts produce
some inhibitory cytokines
after being activated by T-cells what do B-cells do
produce antibodies RF and Anti-CCP
what do RF and anti-CCP cause
synovial cell proliferation, synovitis and potential tissue damage
what do -mab drugs block
cytokines (especially TNF-alpha)
what effect does TNF-alpha have on hepatocytes
stimulates C-reative protein (CRP)
what does prolonged inflammation lead to
bone damage
5 consequences of chronic systemic inflammation
- early IHD
- hypercholesterolaemia
- osteoporosis
- insulin resistance
- sacropenia
why is there increased CV mortality with RA
accelerated atherosclerosis
what inflammatory markers can predict erosion
ESR
CRP
HAQ=
health questionnaire used to assess function
most common joint disorder=
osteoarthritis
joints affected in osteoarthritis (4)
DIP
PIP
CMC
MTPI
when do you get symptoms with osteoarthritis
with activity
6 risk factors for Osteoarthritis
age female sex genetics obesity oestrogen deficiency BMD
central core treatments for osteoarthritis (3)
- education and information
- exercise and strengthening
- weight loss
what builds up over time with recurrent gout
soft tissue deposits of uric acid called tofi
why aren’t women as susceptible to gout
oestrogen stimulates the kidneys to excrete more uric acid
3 common comorbidities in gout
renal impairment
coronary heart disease
metabolic syndrome
what diet is bad for gout
high-purine diet
uric acid formation uses which pathway
purine metabolic pathway
key enzymes in purine metabolic pathway
xanthine oxidase
2 medications targeting xanthine oxidase
allopurinol, febuxostat
2 ways uric acid can accumulate
over production of urate
underexcretion of urate
4 triggers for gout attacks
- direct trauma
- medications
- rapid weight loss
- dehydration/ acidosis
podagra=
gout affecting big toe
how do gout attacks often start
rapidly over night or in the early morning
what joint are 50% of gout attacks in
metatarsophalangeal joint of first toe
what is present in joints in gout
monosodium urate crystals
what do men with gout have a large increase risk of
kidney stones
attacks of gout caused by
deposition of urate crystals in joints resulting in inflammation
what allows gout diagnosis (2)
crystals in joints or tophus aspirate
most common bacteria causes septic arthritis
Staphylococcus aureus
antibiotic regime for septic arthritis
IV antibiotics for 2 weeks then 4 weeks oral antibiotics on return home
