Lec 6 Swan Necks and Bayonets (RA) Flashcards
Rheumatoid arthritis (RA) is typically (asymmetric/symmetric)
symmetric
___ cells in the _____ _____ are the primary orchestry of the immune response in RA
CD4; synovial membrane
Cytokines stimulate these three cell types: ____ ______ _____ to release _____ and _____ that erode bone and cartilage
chondrocytes, fibroblasts, osteoclasts;
metallo proteinases, catalepsins
PMNs release ____ and ____ that degrades cartilage
elastase, protease
____ and ____ function to down regulate the inflammatory response
IL 4, IL10
The normal synovial membrane is ___ cell(s) thick. Early in RA it becomes _____
one; thickened due to hyperplasia/hypertrophy
In established RA, the synovial membrane is transformed into inflamed _____ tissue, called a _____
granulation; pannus
The pannus is made of type A (MQ-like) and type B (fibroblast like) ____ + ____ cells
synoviocytes; plasma
Is RA typically polyarticular or mono articular? Gradual or acute onset?
poly;
gradual onset of weeks to months
Describe the progression of stiffness in a day with RA
morning stiffness lasting hours that gets better throughout the day
RA is an inflammatory arthritis involving the ____. Joints have a warm ____ feel.
synovium;
“soft and squishy”
RA typically spares the ____ hand joints and the ____
DIP, back
Characteristic deformities:
____ deviation
____ neck deformities
B____ and B_____ deformities
ulnar;
swan;
boutenaire, bayonet
Characteristic deformities:
heel ____
cervical damage and ____ instability
MTP ____
valgus;
atlantoacial
sublaxation
Extra-articular involvement:
Rheumatoid ___ and ____
nodules, vasculitis
Extra-articular and systemic involvement is ___
common
Felty’s syndrome: triad of
RA, neutorpenia, splenomegaly
sometimes leg ulcers
RBC’s attract ____ in an inflamed state, so they settle ____
better; faster
Rheumatoid factors: ___ antibodies directed to the ___ portion of ____
IgM, Fc; IgG
What is the other serologic test besides Rheumatoid factor?
cyclic citrullinated peptide antibodies (Anti CCP)
Anti CCP is very ____. Rf is more _____
specific; sensitive
X-ray findings: ______ ____ = ‘washed out bone’
____ gap between bones
peri-articular osteopenia
smaller
_____ _____ is characterized by acute onset of pain in the shoulders and hips in older individuals. Characterized as “turning a corner”
polymyalgia rheumatica
polymyalgia rheumatica is very responsive to _____
corticosteroids
NSAIDS: concern of ___ toxicity has been decreasing, but concern for ____ toxicity is increasing
GI; cardiovascular
Side effects of corticosteroids:
Skin: thinning, ____ and ____
Eye: cataracs and ____
Heart: _____
purpura, striae;
glaucoma;
atherosclerosis
What anti-malarial is a DMARD?
hydroxychlorquin
Hydroxychloroquine works by interfence of cellular compartments in which there is an ____ microenviornment
acidic; ie lysosomes, endosomes
Side effect of hydroxychloroquine to Look out for
retinal toxicity 0_0
Sulfasalazine inhibits production of ____ such as LTB4, hydroxyeicosatetraenoic acid, TXA2
prostanoids
Sulfasazine results in reduction of circulating of activated ____ and inhibition of ___ cell activation
lymphocytes;
B
Side effects of sulfasalzine:
myelosuppresion, photosensitivity
What elemental therapy is sometimes used for RA
gold
Methotrexate and azathiporine affect synthesis of ____
purines
Leflunomide (Arava) inhibits production of _____
pyrimadines
What should you monitor purine/pyrimadine synthesis inhibitors for?
myelosupression
_____ antagonists include Etanercept, Infliximab, and Humira.
TNF alpha
Anakinra is a ____ receptor antagonist
IL1
____ is a recombinant fusion protien of extracellular domain of CTLA4 and the constant portion of an IgG
Abatacept
What triple therapy has been shown to be more effective than methotrexate aloone?
methotrexate + sulfasalazine + hydroxychloroquin
Multidrug therapy or ___ blocker therapy should generally be administered early.
TNF alpha
