Pathophysiology of inflammatory and degenerative joint disease

Question 1

5 word description of rheumatoid arthritis:

Answer 1

Chronic, symmetrical, inflammatory, deforming, polyarthritis

Question 2

Which joints does RA usually not effect?

Answer 2

distal interphalangeal joints

Question 3

EMS =

Answer 3

Early morning stiffness

Question 4

2 antibodies tested for in RA:

Answer 4

• Rheumatoid factor

- Anti-citrullinated protein antibody (Anti-CCP)

Question 5

Which cytokines can play a bid role in RA?

Answer 5

Tumour necrosis factor alpha (TNF-a)

Question 6

Functions of TNF-a in RA (6):

Answer 6

1. Increases pro-inglammatiory cytokines and chemokine (IL-1, IL-6, IL-8)
2. Increase adhesion molecules
3. Increase vascular endothelial growth factor
4. Increase acute phase response
5. Increase Keratinocyte hyper proliferation
6. Increase metalloproteinase synthesis

Question 7

Function of vascular endothelial growth factor (VEGF)

Answer 7

Increased angiogenesis

Question 8

CRP:

Answer 8

C-reactive protein, part of the acute phase response. Broad inflammatory marker.

Question 9

What does increased keratinocyte hyper proliferation cause?

Answer 9

Skin plaques

Question 10

In RA, what is the bone eroded by?

Answer 10

Osteoclasts (RANK-L expression increased in other cells activated them).

Question 11

List some systemic problems in RA:

Answer 11

• Skeletal muscle breakdown
• Rheumatoid nodules
• Fever
• Pleural effusion
• Increased hepcidin, decreased iron
• Atheromatous plaques in blood vessels

Question 12

Which type of arthritis is often asymmetrical?

Answer 12

Osteoarthritis

Question 13

Risk factors for OA:

Answer 13

Female, age, family history, obesity, oestrogen deficiency, occupation, past trauma

Question 14

Treatment aims in OA:

Answer 14

Patient education and information access
Pain relief
Optimisation of function
Modification of disease process

Question 15

What is the most common inflammatory arthritis in men?

Answer 15

Gout

Question 16

Name 3 common comorbidities in gout:

Answer 16

• Renal impairment
• Coronary heart disease
• Metabolic syndrome (obesity, dyslipidaemia, hypertension, T2 diabetes)

Question 17

Non-modifiable risk factors for gout:

Answer 17

Age, male, race, genetic factors, impaired renal function

Question 18

Modifiable risk factors for gout:

Answer 18

Hyperuricaemia, high-purine diet, alcohol consumption, obesity, certain meds (e.g. diuretics)

Question 19

Hyperuricaemia =

Answer 19

Abnormally high levels of uric acid in the blood.

Question 20

where does urate in the body come from?

Answer 20

• Cell turn over

- Diet

Question 21

Ways to modify risk of gout:

Answer 21

• Modify purine-rich foods
• Reduce alcohol intake
• Obesity
• Modify medications

Question 22

What are purines broken down into?

Answer 22

Uric acid - excretes in the urine

Question 23

What can cause too much rate in blood?

Answer 23

• over productions (increased synthesis, high cell turn-over)
• increased consumption of purines
• under excretion of purines

Question 24

Podagra =

Answer 24

a classic symptom of gout. gout affecting the big toe.