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Intro to D&D Midterm > Pathophys - Rheumatoid Arthritis > Flashcards

Pathophys - Rheumatoid Arthritis Flashcards

1
Q

true or false

rheumatoid arthritis is chronic

A

truee

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2
Q

explain what type of disorder rheumatoid arthritis is

A

chronic inflammatory autoimmune disorder

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3
Q

true or false

the primary targets of rheumatoid arthritis are the joints, but other tissues may be affected

A

true

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4
Q

which particular joints are most commonly affected by rheumatoid arthritis?

A

small joints, like in the hands and feet

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5
Q

true or false

arthritis is always acute

A

FALSE
can be acute or chronic

acute occurs as a result of injury. signs are heat, pain, redness swelling OR due to an infectious agent (stab wound, osteomyelitis (bone infection))

there are 2 chronic arthritises - rheumatoid and osteo

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6
Q

explain the difference between the triggers for rheumatoid vs osteoarthritis

A

osteoarthritis typically arises as a result of repeated injuries, or “ware and tare” on the joints

rheumatoid arthritis on the other hand can arise without any previous injury

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7
Q

true or false

arthritis that develops in the foot after repeated injuries is an example of osteoarthritis

A

true

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8
Q

true or false

rheumatoid arthritis is an autoimmune response

A

true

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9
Q

true or false

osteoarthritis is an autoimmune disease

A

FALSE - caused by wear and tear

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10
Q

if arthritis is bilateral, is it most likely rheumatoid or osteo?

A

rheumatoid

CAN be osteo, but rheumatoid is characteristically bilateral

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11
Q

true or false

rheumatoid arthritis cannot be unilateral

A

false - it can, it’s just not as common as bilateral

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12
Q

joints typically affected: wrists, hands, elbows, shoulders, knees, and ankles

is this most likely rheumatoid or osteo?

A

rheumatoid

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13
Q

which type of arthritis affects larger joints typically

A

osteoarthritis

rheumatoid is typically smaller joints like hands and feet

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14
Q

what does autoimmunity mean?

A

when the body produces immune cells/antibodies targeted at an antigen WITHIN THE HOST - destroying self

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15
Q

what is “self tolerance” and how does it relate to rheumatoid arthritis

A

self tolerance is the ability to distinguish self vs nonself and thus not attack self

in rheumatoid arthritis, this self tolerance is somewhat lost

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16
Q

explain what profile of a person is most likely to develop rheumatoid arthritis

A

women are more likely than men
women particularly of childbearing age are most likely

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17
Q

true or false

rheumatoid arthritis mainly affects those that are older

A

FALSE - onset is typically in women of childbearing age, and the condition is chronic so they carry it for the rest of their lives

thus, this disorder is seen in the elderly but its onset is usually in younger people

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18
Q

explain the “pattern” that rheumatoid arthritis presents itself

A

there is a pattern of exacerbation and remission

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19
Q

in terms of therapy/drug use, what is the goal in treating rheumatoid arthritis patients?
why?

A

the goal is to keep exacerbation periods to a minimum and remission periods to a maximum. NOT TO CURE THE CONDITION - we don’t know the exact cause - not possible to cure yet

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20
Q

WHY do we want to keep exacerbation periods to a minimum, aside from limiting pain?

A

during exacerbation periods, tissue is PERMANENTLY damaged. therefore, prolonged and frequent exacerbation periods can result in a decline in function of the joint over time and a lower quality of life

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21
Q

what is the cause of rheumatoid arthritis?

A

the cause is unclear, but it’s thought to be a combination of factors, at the heart of which is genetics

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22
Q

how is it possible that we can treat rheumatoid arthritis but not cure it?

A

we know that it is an autoimmune response that works through the inflammatory process.
therefore, we can treat this inflammatory process with anti inflammatories and other pain meds

however, we do not know the cause of the disease, so there is no cure

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23
Q

name 2 genes that seem to be common in RA patients

A

NVM HE SAID NOT TO KNOW

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24
Q

true or false

a patient with high levels of HLADR4 and HLADRB1 have rheumatoid arthritis

A

FALSE

it is likely that they do, but they may not. it is not a 100% correlation

some ppl have RA yet not these markers

25
Q

what markers for RA are often (but not always) cases that are difficult to treat?

A

NVM HE SAID NOT TO KNOW

26
Q

True or false

environmental factors are not thought to play a role in the causation of RA

explain

A

false - it’s possible

-c-reactive protein is high in some RA patients

-anticitrulline antibody

-RF (rheumatoid factor)

-antinuclear antibody

27
Q

explain the hesitancy in treating RA patients

A

this disease is very rarely life threatening
it’s possible that treatment to relieve symptoms can be worse than the disease itself

for example, prolonged use of corticosteroids and even aspirin and ibuprofen can cause issues

also, immunosuppressing agents can be used to treat this disorder, but not recomended for long periods - risk of infection

28
Q

true or false

the injury process done by rheumatoid arthritis cannot be reversed

A

true

29
Q

explain C-reactive protein and its relation to rheumatoid arthritis

A

it’s a liver protein that increases during inflammation in response to IL6.
it is a RESPONSE to the inflammation occuring - not the CAUSE

the higher the level of CRP, RA seems to be more severe

this is because CRP binds phosphocholine in the membranes of bacteria to activate complement. this in turn promotes phagocytosis by macrophages to remove dead cells.

thus, increased CRP due to inflammation leads to more movement of cells to the site of injury and more cells destroyed and thus more tissue injury

leads to worse RA symptoms

30
Q

why is C reactive protein released?

A

in RESPONSE to inflammation

31
Q

true or false

c reactive protein is not thought to be a cause of RA

A

TRUE

not a cause, but a result of the inflammation already occuring. makes RA worse, but not the cause
released from liver in response to inflammation

32
Q

besides promoting more injury to the joint area, why else is increased CRP a concern in RA patients

A

CRP influences osteoclasts to resorb bone

this increases the likelihood of the patient developing osteoporosis, more frequently a concern in women

increased CRP is also associated with increased risk of cardiovascular diseases, metabolic syndrome, diabetes, etc

33
Q

how are anti-citrullinated antibodies related to RA?
explain

A

arginine (amino acid) residues in proteins can be enzymatically converted to CITRULLINE

citrulline, in turn, appears foreign to our immune system and serves as an antigen. this can make the entire protein appear foreign and an antibody can be produced against the tissue that contains this protein with an arginine converted to cittruline

THUS, the presence of these antibodies can help to diagnose RA

34
Q

true or false

the presence of anti-citrullinated antibody is a useful diagnostic tool

A

true

35
Q

______ citrullinate vementin

A

macrophages

36
Q

why does it matter that we have markers to diagnose RA if it’s chronic anyway?
name 3 potential markers of RA

A

bc we want to find out what it is as early as possible so that we can treat and limit the damage done

CRP
anti-citrullinated antibody
RF

37
Q

explain what RF (rheumatoid factor) is and how it relates to RA

A

it is an autoantibody commonly found in RA patients and is thus a useful marker in diagnosis

the antibody is directed against the Fc portion of IgG antibody

38
Q

true or false

RF is an antibody against self

A

true - autoantibody

39
Q

true or false

RF is potentially the cause for RA

A

FALSE - not the cause

cause is still unknown

40
Q

RF is usually which isotype?

A

usually IgM, but can be any isotype

41
Q

as mentioned, RA typically affects small joints of the hands and feet.

name 3 other tissues that can potentially be damaged by RA

A

cardiovascular disease
osteoporosis
interstitial lung disease

this is when RA becomes a much bigger concern - CV issues and interstitial lung disease can quickly become fatal

42
Q

name the 3 phases of RA progression

A

initiation
amplification
chronic inflammatory phase

43
Q

further classify the 1st phase of RA

A

initiation - nonspecific inflammation

44
Q

what causes the 2nd phase of RA progression?

A

amplification - caused by T-lymphocyte activation

45
Q

as mentioned, phase 3 of RA progression is a chronic inflammatory phase

what is thought to cause the tissue injury?

A

inflammatory cytokines like IL-1 TNFa, IL-6

46
Q

explain what happens to the synovial membrane in RA patients

A

the synovial membrane is inflamed and has a lot of inflammatory cells like lymphocytes, PMNS, and plasma cells

these massive amounts of cells form a PANNUS or a mass on the synovial space side of the membrane

synovial cells also proliferate and increase activity

47
Q

explain how RA injury can extend to cartilage and even bone

A

capsular structures thicken. the inflammation may extend into the articulating cartilage and then into bone. further and further progression leads to cartilage loss and bone damage.

48
Q

as mentioned, further inflammatory progression of RA can lead to bone damage. be specific

what does this mean for the patient?

A

the head of the bone may be eroded by granulation tissue.
this leads to a deformed joint, making articulation and thus MOVEMENT difficult for the patient

49
Q

in RA progression, more inflammation can lead to cartilage loss and bone damae, as well as __ and ___ destruction

A

joint and ligament destruction

50
Q

where are rheumatoid nodules normally found?

A

subcutaneous (UNDER THE SKIN) most often over a bony area like the forearm, distal to the elbow

51
Q

rheumatoid nodules are formed around what?

A

a fibrinoid center

52
Q

the fibrinoid center is usually surrounded by what?

A

a palisade region, made of macrophages and fibroblasts

53
Q

peripheral to the palisade layer is what

A

region of t cells and b cells (plasma cells)

54
Q

the OUTER region of the nodules has what?

A

usually rich in blood vessels

55
Q

explain the layers of rheumatoid nodules

A

fibrinoid center, surrounded by palisade layer (macrophages and fibroblasts), surrounded by layer of T cells and plasma cells, surrounded by rich network of blood vessels

56
Q

true or false

blood cannot be affected by RA

A

false - it can

57
Q

how can the skin be affected by RA?

A

development of nodules under the skin

58
Q

as mentioned, RA can affect the CVS and lungs

what are some other less common things that can be affected?
what is the cause of this?

A

kidney, eyes, liver, nervous system, bone
-connective tissue of these structures is affected

due to cellular infiltration of lymphocytes

59
Q
A

Intro to D&D Midterm (29 decks)

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