MSK 02

Question 1

What is Rheumatoid arthritis is?

Answer 1

Chronic & Systemic

Joint destruction, Deformity, Loss of function.

Question 2

What is the epidemiology (cause, control etc.) of RA?

Answer 2

• Gender: Affects rate 3 times more than a man
• Age: 35 to 50years
• 3 times higher mortality rate compared with who do not have this disease.

Question 3

What are the Hallmark signs of RA?

Answer 3

Persistent inflammation:
Mainly affects to peripheral joints
Polyarthritis (More than one joint)
Usually symmetrical it means if it affects in one hand it will affect the other hand too.
Other signs hands, wrists, elbows knee and shoulder.

Question 4

What is the Etiology (Cause) of RA?

Answer 4

Genetic: First degree relatives at higher risk, Identical tweens.
Environmental: Smoking, need to stop smoking, alcohol.

Question 5

What is the Mechanism of RA?

Answer 5

Smoking, Gene, and other environmental factors activate of humoral immunity=> activation of synovial inflammation=>which leads to bone and cartilage destruction.

On the other hand, if we think about, in molecular level, the MOA is: Macrophages, T cells, B cells are involved leading to joint destruction.

Question 6

What is the Pathogenesis (manner of development of a disease) of RA?

Answer 6

So, in a normal joint we can see synovial membrane, cartilage and joint space.
But RA affected joints we will see a massive presence of proinflammatory cells in the joints like macrophage, Plasma cells, Dendritic cells, Neutrophils, lymphocytes etc and result the synovial membrane got inflamed, Cartilage has been destroyed, joint become scratched and with reduced spaces between bones cause inflammation.

Question 7

Some cytokines are the major player

What releases them?

Answer 7

Pathogenesis Steps include:
Step 1: Exposure of genetically susceptible host to unknown antigen i.e smoking or gene or another factor
Steps 2: Antigen presenting cells activate T cells and B cells
Step 3: As a result, release of proinflammatory cytokines TNF alpha Result joint inflammation.
Step 4: MMPs=> degrade cartilage
Step 5: RANKL activate osteoclasts=> degrade bone. (Bone destruction)
Step 6: Pannus formation: Synovial tissue cytokines and fibroblasts growing over cartilage and causing erosion.

Question 8

What RANKL does?

Answer 8

Osteoclasts (destruction of bone).

Question 9

What is the main target for anti RA drugs?

Answer 9

TNF alpha, IL-1, IL-06, is the main target of RA

Question 10

What MMPs degrade?

Answer 10

Cartilage

Question 11

Osteoclasts mean?

Answer 11

Degrade Bone joint

Question 12

In a radiograph how it is looks like?

Answer 12

Joint displacement and joint erosion or destruction.

Question 13

What are the sign and symptoms of RA?

Answer 13

Systemic manifestations.
Fatigue 
Weakness 
Fever
Articular sign:
Muscle and joint pain.
Symmetric  
Morning stiffness more than 30 min
Extra-articular sign:
Rheumatoid nodules
Palmar erythema
Vasculitis
Other sign and symptoms 
Ocular inflammation
Cardiac 
Neuromuscular

Question 14

What are the Tests available for RA?

Answer 14

(RF) Rheumatoid factors (IgM auto antibody) test: but It is not specific for all patients.
ACPA (Anti-citrullinated protein antibodies) test: This is more specific than RF and can detect early disease.
EST test: but not specific anything in the body can increase this.
C-reactive protein test: this is also not specific.
Synovial fluid analysis: under microscope and can see WBC presence.
Radiological evaluation. For bone erosion.

Question 15

What is the goal of RA therapy?

Answer 15

RA do not have any treatment
But the goal of treatment is
Remission of disease (reduce inflammation)
Control joint destruction
Maintain functional ability and quality of life.

Question 16

Abbreviation of DMARD?

Answer 16

Disease Modifying Anti Rheumatoid drugs.