Lec 6 Swan Necks and Bayonets (RA)

Question 1

Rheumatoid arthritis (RA) is typically (asymmetric/symmetric)

Answer 1

symmetric

Question 2

___ cells in the _____ _____ are the primary orchestry of the immune response in RA

Answer 2

CD4; synovial membrane

Question 3

Cytokines stimulate these three cell types: ____ ______ _____ to release _____ and _____ that erode bone and cartilage

Answer 3

chondrocytes, fibroblasts, osteoclasts;

metallo proteinases, catalepsins

Question 4

PMNs release ____ and ____ that degrades cartilage

Answer 4

elastase, protease

Question 5

____ and ____ function to down regulate the inflammatory response

Answer 5

IL 4, IL10

Question 6

The normal synovial membrane is ___ cell(s) thick. Early in RA it becomes _____

Answer 6

one; thickened due to hyperplasia/hypertrophy

Question 7

In established RA, the synovial membrane is transformed into inflamed _____ tissue, called a _____

Answer 7

granulation; pannus

Question 8

The pannus is made of type A (MQ-like) and type B (fibroblast like) ____ + ____ cells

Answer 8

synoviocytes; plasma

Question 9

Is RA typically polyarticular or mono articular? Gradual or acute onset?

Answer 9

poly;

gradual onset of weeks to months

Question 10

Describe the progression of stiffness in a day with RA

Answer 10

morning stiffness lasting hours that gets better throughout the day

Question 11

RA is an inflammatory arthritis involving the ____. Joints have a warm ____ feel.

Answer 11

synovium;

“soft and squishy”

Question 12

RA typically spares the ____ hand joints and the ____

Answer 12

DIP, back

Question 13

Characteristic deformities:
____ deviation
____ neck deformities
B____ and B_____ deformities

Answer 13

ulnar;
swan;
boutenaire, bayonet

Question 14

Characteristic deformities:
heel ____
cervical damage and ____ instability
MTP ____

Answer 14

valgus;
atlantoacial
sublaxation

Question 15

Extra-articular involvement:

Rheumatoid ___ and ____

Answer 15

nodules, vasculitis

Question 16

Extra-articular and systemic involvement is ___

Answer 16

common

Question 17

Felty’s syndrome: triad of

Answer 17

RA, neutorpenia, splenomegaly

sometimes leg ulcers

Question 18

RBC’s attract ____ in an inflamed state, so they settle ____

Answer 18

better; faster

Question 19

Rheumatoid factors: ___ antibodies directed to the ___ portion of ____

Answer 19

IgM, Fc; IgG

Question 20

What is the other serologic test besides Rheumatoid factor?

Answer 20

cyclic citrullinated peptide antibodies (Anti CCP)

Question 21

Anti CCP is very ____. Rf is more _____

Answer 21

specific; sensitive

Question 22

X-ray findings: ______ ____ = ‘washed out bone’

____ gap between bones

Answer 22

peri-articular osteopenia

smaller

Question 23

_____ _____ is characterized by acute onset of pain in the shoulders and hips in older individuals. Characterized as “turning a corner”

Answer 23

polymyalgia rheumatica

Question 24

polymyalgia rheumatica is very responsive to _____

Answer 24

corticosteroids

Question 25

NSAIDS: concern of ___ toxicity has been decreasing, but concern for ____ toxicity is increasing

Answer 25

GI; cardiovascular

Question 26

Side effects of corticosteroids:
Skin: thinning, ____ and ____
Eye: cataracs and ____
Heart: _____

Answer 26

purpura, striae;
glaucoma;
atherosclerosis

Question 27

What anti-malarial is a DMARD?

Answer 27

hydroxychlorquin

Question 28

Hydroxychloroquine works by interfence of cellular compartments in which there is an ____ microenviornment

Answer 28

acidic; ie lysosomes, endosomes

Question 29

Side effect of hydroxychloroquine to Look out for

Answer 29

retinal toxicity 0_0

Question 30

Sulfasalazine inhibits production of ____ such as LTB4, hydroxyeicosatetraenoic acid, TXA2

Answer 30

prostanoids

Question 31

Sulfasazine results in reduction of circulating of activated ____ and inhibition of ___ cell activation

Answer 31

lymphocytes;

B

Question 32

Side effects of sulfasalzine:

Answer 32

myelosuppresion, photosensitivity

Question 33

What elemental therapy is sometimes used for RA

Answer 33

gold

Question 34

Methotrexate and azathiporine affect synthesis of ____

Answer 34

purines

Question 35

Leflunomide (Arava) inhibits production of _____

Answer 35

pyrimadines

Question 36

What should you monitor purine/pyrimadine synthesis inhibitors for?

Answer 36

myelosupression

Question 37

_____ antagonists include Etanercept, Infliximab, and Humira.

Answer 37

TNF alpha

Question 38

Anakinra is a ____ receptor antagonist

Answer 38

IL1

Question 39

____ is a recombinant fusion protien of extracellular domain of CTLA4 and the constant portion of an IgG

Answer 39

Abatacept

Question 40

What triple therapy has been shown to be more effective than methotrexate aloone?

Answer 40

methotrexate + sulfasalazine + hydroxychloroquin

Question 41

Multidrug therapy or ___ blocker therapy should generally be administered early.

Answer 41

TNF alpha