Lecture 25 - Intro to RA Flashcards

1
Q

There are more than ___different types of arthritis

A

There are more than 100 different types of arthritis

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2
Q

IN adult caucasian populations _% will have RA

A

1%

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3
Q

RA leads to …

A

Progressive disability
reduced life expectancy
Significant socioeconomic costs

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4
Q

The Primary manifestation of RA is

A

Synovitis

erosion of bone cartilage, peri-articular strutures

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5
Q

Genetic susceptibility + environmental facts leads to a

A

breakdown of immune tolerance (self-reactive antibody or T cells - autoimmune disease

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6
Q

Genetic risk factors accounts for ___% of disease suseptabillity

A

50-60%

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7
Q

The HLA class _ genes are most important in Ra

A

2

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8
Q

what is HLA

A

Group of genes, exists on arm of chr. 6

divides in to 3 broad regions

Class 2 is of interest

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9
Q

Which alleles in Class 2 of HLA are of interst?

A

DRB-1

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10
Q

Citrulline is an

A

arthritogenic or (arthritis promoting gene)

they bind extremely well to the shared epitope of APC

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11
Q

Citrulline can cause ___expression, which is used for RA diagnosis

A

Anti-citrillinated protein anibodies

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12
Q

Shared epitope can influence _____selection of autoimmune T cells

A

Thymic

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13
Q

Shared epitope is mimicked by which virus?

A

epstein barr virus

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14
Q

Cohort with recent-onset undifferentiated (ACPA+) arthritis, progression to RA occurred regardless of ____-_____

A

HLA-DR genotype

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15
Q

Maternal cells of SE-expressing women persist in their children’s circulation throughout adulthood, which confers

A

increased RA risk

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16
Q

THere are non-HLA genes conferring RA risk

they are?

A

PTPN22
PAD14

among others….

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17
Q

True or False

Epigenetic risk factors for RA may be heritable

A

true

DNA methylation - can have unusualness in RA

also, microRNAs

18
Q

oestrogen exposure - B cells that produce autoantibodies are ___ resistant to apoptosis

19
Q

in the presense of oestrogen Fibroblast-like synoviocytes (FLS) lead to an increase in ______

A

metalloproteinases

20
Q

In preganancy more than 3/4 pateints RA ___

21
Q

True or False

RA can go into remission in the 3rd trimester of pregnancy

22
Q

What is Citrullination?

A

post-translational conversion of the AA Argginine (R) to citrulline by PAD1 enzymes (Peotidyl-arginine deiminase)

Neoepitopes serve as targets for autoimmunity

23
Q

Citrulline binds _____ _____ more avidly

A

shared epitope

24
Q

True or False

Induction of PAD1 expression and peptide citrullination is specific the joint or RA

A

False

Occurs in many different settings of tissue stress/inflammation

25
In humans there are _isoforms of PAD1 enzymes
4
26
What are environmental factors?
pollution smoking - involved in citrullination process Bronchial stress Infections TLR activation (increase PAD enzyme)
27
What will RA patients clinically present with?
Morning stiffness Pain Swelling Symmetrical distribution
28
What are the most commonly affected joints?
Metacarpophalangeal proximal interphelangeal Wrist Metatarspophalangeal
29
RA tends to happen in ____ pateints
younger
30
true or FalseOsteoarthritis is frequently asymmetrical
true
31
RA can involve what extra-articular manifestations?
``` Pulmonary -effusion Ocular Vasculitis Neurological Cardiovascular cutaneous Haematologic Malignancy ```
32
What is the Rheumatoid Factor (RF)?
High-affinity autoantibody against the Fc portion of IgG
33
True or False RF develops prior to RA onset
true
34
The anti0cyclic citrullinated peptide assay (CCP) can detect..
Anti-citrullinated protein antibdies (ACPA)
35
About __% of pateints with RA test positive to RF test
70% - senesitivity
36
The specificity for ACPA is __%
95%
37
A person is __x more likely to test postivie for ACPA if they have RA, compared to someone who doesn't
14x
38
So the two subsets of RA are
seropositive - RF or ACPA positive Seronegative - RF or ACPA negative
39
seropositive patients tend to have more ____ disease
aggressive
40
DAS calculator: below 2.6 is
RA remission
41
DAS of over 5.1 is..
High disease activity
42
subclinical inflammation can be best seen by
MRI