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Molecule to Malady > Lecture 25 - Intro to RA > Flashcards

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

A

more

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 ___

A

improves

21
Q

True or False

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

A

true

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
Q

In humans there are _isoforms of PAD1 enzymes

A

4

26
Q

What are environmental factors?

A

pollution
smoking - involved in citrullination process

Bronchial stress

Infections

TLR activation (increase PAD enzyme)

27
Q

What will RA patients clinically present with?

A

Morning stiffness
Pain
Swelling

Symmetrical distribution

28
Q

What are the most commonly affected joints?

A

Metacarpophalangeal
proximal interphelangeal
Wrist

Metatarspophalangeal

29
Q

RA tends to happen in ____ pateints

A

younger

30
Q

true or FalseOsteoarthritis is frequently asymmetrical

A

true

31
Q

RA can involve what extra-articular manifestations?

A 
Pulmonary -effusion
Ocular
Vasculitis
Neurological
Cardiovascular
cutaneous
Haematologic
Malignancy
32
Q

What is the Rheumatoid Factor (RF)?

A

High-affinity autoantibody against the Fc portion of IgG

33
Q

True or False

RF develops prior to RA onset

A

true

34
Q

The anti0cyclic citrullinated peptide assay (CCP) can detect..

A

Anti-citrullinated protein antibdies (ACPA)

35
Q

About __% of pateints with RA test positive to RF test

A

70% - senesitivity

36
Q

The specificity for ACPA is __%

A

95%

37
Q

A person is __x more likely to test postivie for ACPA if they have RA, compared to someone who doesn’t

A

14x

38
Q

So the two subsets of RA are

A

seropositive - RF or ACPA positive

Seronegative - RF or ACPA negative

39
Q

seropositive patients tend to have more ____ disease

A

aggressive

40
Q

DAS calculator:

below 2.6 is

A

RA remission

41
Q

DAS of over 5.1 is..

A

High disease activity

42
Q

subclinical inflammation can be best seen by

A

MRI

Molecule to Malady (36 decks)

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