Pathophys. of Joint Inflammation Flashcards
What percentage of the population have Rheumatoid arthritis?
1%
What joints are mostly swollen in RA?
MCP, MTPs, PIPs and wrists
Early morning stiffness that eases throughout day is a characteristic sign of OA or RA?
RA
symmetrical polyarthritis is characteristic of OA or RA?
RA - OA tends to not be symmetrical and can be monoarthritic
In RA: you usually have a genetic predisposition for it then get some sort of trigger which causes (1)? to activate (2)? and (3) which, in turn mobilises (4)? such as TNF, IL-1, which drive (5)?.
B-cells are also activated to produce (6)? together with inflammation causes (7)?.
1 - T-cells 2 - Macrophages 3 - Fibroblasts 4 - cytokines 5 - inflammation 6 - antibodies 7 - tissue damage
Early intervention with RA makes a difference to reducing effects. True or false?
True - the damage to articular cartilage is permanent so want to try and intervene early to prevent this
List some of the cells that TNF-alpha acts on in RA and the outcome of this.
T-lymphocytes and macrophages –> pro inflammatory cytokines, increased adhesion molecules –> increased inflammation and cell infiltration
Endothelium –> VEGF –> increased angiogenesis
Hepatocytes –> increased CRP
Epidermis –> keratinocyte hyperproliferation –> skin plaques
synoviocytes –> increased metalloproteinase syntehsis –> articular cartilage degradation
List some of the 7 consequences of chronic systemic inflammation
- early ischaemic heart disease
- sarcopenia (loss of muscle strength)
- hypercholestrolaemia
- pain sensitisation
- osteoporosis
- insulin resistance
- dementia
What process occurs that makes people with RA at a higher risk of CVD?
Accelerated atherosclerosis
What two things detected in an autoimmune profile could indicate RA and which is more specific?
Rheumatoid factor and anti-CCP. Anti-CCP is more specific.
What joints are more commonly affected in OA?
DIP, PIP, CMC, MTPI, axial skeleton and large wt-bearing joints
List some risk factors for Osteoarthritis
- age (older people affected more)
- female
- genetic fam. hx
- obese
- oestrogen deficiency
- low BMD
- occupation (e.g. manual labour)
- past fractures
How prevalent is OA in people over 75?
80%
What are the 4 management objectives for OA?
- patient education and information access
- Pain relief
- Optimisation of function
- Modification of disease process
What is an example of a type of crystal arthritis?
Gout
Is gout more common in men or women?
Men
Name some common comorbidities in gout
- Renal impairment
- CHD
- Metabolic syndromes (e.g. hypertension, diabetes, obesity, dyslipidaemia)
List some non-modifiable risk factors for gout
- age (prevalence ^ with age)
- male gender
- race (afroamerican more at risk than caucasians)
- genetic factors
- impaired renal function
list some modifiable risk factors of gout
- hyperuricaemia
- high purine diet (seafood, red meat)
- alcohol consumpton (particularly beer)
- obesity
- certain medications (e.g. diuretics, aspirin, some cytotoxic drugs etc.)
The precipitation of what crystals in joints causes inflammation which causes gout?
urate (uric acid).
Hyperuricaemia is the cause of gout.
What drug is used to treat gout and what is its mechanism of action?
Allopurinol - blocks xantine oxidase whcih reduces amount of uric acid in body
Triggers of gout
- direct trauma
- intercurrent illness (or surgery) that triggers the acute phase response
- dehydration/acidosis (including alcoholic binge)
- medications
- rapid weight loss
Is gout usually slow or quick-onset
quick - people may wake up in middle of light in pain suddenly
What is the name of the condition where you get recurrent attacks of gout over time and the swelling is hard crystals?
Chronic tophaceous gout
Inflammation of the Metatarsophalangeal joint in the big toe caused by gout is known as what?
Podagra
What two bacteria most commonly cause septic arthritis?
Staphylococcus or Streptococcal
what systemic symptoms might you see in septic arthritis?
- fever
- sweats
- rigors
- confusion
What from the history might make you think it’s septic arthritis?
Sudden recent increase in joint swelling. Joint - heat, erythematous, loss of function and effusion
How is septic arthritis diagnosed?
Joint aspiration then culturing the aspirate
