Pathophys - Rheumatoid Arthritis Flashcards
true or false
rheumatoid arthritis is chronic
truee
explain what type of disorder rheumatoid arthritis is
chronic inflammatory autoimmune disorder
true or false
the primary targets of rheumatoid arthritis are the joints, but other tissues may be affected
true
which particular joints are most commonly affected by rheumatoid arthritis?
small joints, like in the hands and feet
true or false
arthritis is always acute
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
explain the difference between the triggers for rheumatoid vs osteoarthritis
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
true or false
arthritis that develops in the foot after repeated injuries is an example of osteoarthritis
true
true or false
rheumatoid arthritis is an autoimmune response
true
true or false
osteoarthritis is an autoimmune disease
FALSE - caused by wear and tear
if arthritis is bilateral, is it most likely rheumatoid or osteo?
rheumatoid
CAN be osteo, but rheumatoid is characteristically bilateral
true or false
rheumatoid arthritis cannot be unilateral
false - it can, it’s just not as common as bilateral
joints typically affected: wrists, hands, elbows, shoulders, knees, and ankles
is this most likely rheumatoid or osteo?
rheumatoid
which type of arthritis affects larger joints typically
osteoarthritis
rheumatoid is typically smaller joints like hands and feet
what does autoimmunity mean?
when the body produces immune cells/antibodies targeted at an antigen WITHIN THE HOST - destroying self
what is “self tolerance” and how does it relate to rheumatoid arthritis
self tolerance is the ability to distinguish self vs nonself and thus not attack self
in rheumatoid arthritis, this self tolerance is somewhat lost
explain what profile of a person is most likely to develop rheumatoid arthritis
women are more likely than men
women particularly of childbearing age are most likely
true or false
rheumatoid arthritis mainly affects those that are older
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
explain the “pattern” that rheumatoid arthritis presents itself
there is a pattern of exacerbation and remission
in terms of therapy/drug use, what is the goal in treating rheumatoid arthritis patients?
why?
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
WHY do we want to keep exacerbation periods to a minimum, aside from limiting pain?
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
what is the cause of rheumatoid arthritis?
the cause is unclear, but it’s thought to be a combination of factors, at the heart of which is genetics
how is it possible that we can treat rheumatoid arthritis but not cure it?
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
name 2 genes that seem to be common in RA patients
NVM HE SAID NOT TO KNOW
true or false
a patient with high levels of HLADR4 and HLADRB1 have rheumatoid arthritis
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
what markers for RA are often (but not always) cases that are difficult to treat?
NVM HE SAID NOT TO KNOW
True or false
environmental factors are not thought to play a role in the causation of RA
explain
false - it’s possible
-c-reactive protein is high in some RA patients
-anticitrulline antibody
-RF (rheumatoid factor)
-antinuclear antibody
explain the hesitancy in treating RA patients
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
true or false
the injury process done by rheumatoid arthritis cannot be reversed
true
explain C-reactive protein and its relation to rheumatoid arthritis
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
why is C reactive protein released?
in RESPONSE to inflammation
true or false
c reactive protein is not thought to be a cause of RA
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
besides promoting more injury to the joint area, why else is increased CRP a concern in RA patients
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
how are anti-citrullinated antibodies related to RA?
explain
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
true or false
the presence of anti-citrullinated antibody is a useful diagnostic tool
true
______ citrullinate vementin
macrophages
why does it matter that we have markers to diagnose RA if it’s chronic anyway?
name 3 potential markers of RA
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
explain what RF (rheumatoid factor) is and how it relates to RA
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
true or false
RF is an antibody against self
true - autoantibody
true or false
RF is potentially the cause for RA
FALSE - not the cause
cause is still unknown
RF is usually which isotype?
usually IgM, but can be any isotype
as mentioned, RA typically affects small joints of the hands and feet.
name 3 other tissues that can potentially be damaged by RA
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
name the 3 phases of RA progression
initiation
amplification
chronic inflammatory phase
further classify the 1st phase of RA
initiation - nonspecific inflammation
what causes the 2nd phase of RA progression?
amplification - caused by T-lymphocyte activation
as mentioned, phase 3 of RA progression is a chronic inflammatory phase
what is thought to cause the tissue injury?
inflammatory cytokines like IL-1 TNFa, IL-6
explain what happens to the synovial membrane in RA patients
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
explain how RA injury can extend to cartilage and even bone
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.
as mentioned, further inflammatory progression of RA can lead to bone damage. be specific
what does this mean for the patient?
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
in RA progression, more inflammation can lead to cartilage loss and bone damae, as well as __ and ___ destruction
joint and ligament destruction
where are rheumatoid nodules normally found?
subcutaneous (UNDER THE SKIN) most often over a bony area like the forearm, distal to the elbow
rheumatoid nodules are formed around what?
a fibrinoid center
the fibrinoid center is usually surrounded by what?
a palisade region, made of macrophages and fibroblasts
peripheral to the palisade layer is what
region of t cells and b cells (plasma cells)
the OUTER region of the nodules has what?
usually rich in blood vessels
explain the layers of rheumatoid nodules
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
true or false
blood cannot be affected by RA
false - it can
how can the skin be affected by RA?
development of nodules under the skin
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?
kidney, eyes, liver, nervous system, bone
-connective tissue of these structures is affected
due to cellular infiltration of lymphocytes
