Pathophysiology of Rheumatoid Arthritis Flashcards
What is the specific gene in the genetic predisposition of RA?
HLA-DR4
What is Rheumatoid Arthritis?
Unidentifiable etiologic factor, complex inflammatory response, with progressive activation of many cell types
What is the mortality of RA?
Chronic disease, mortality increases with severity
What are the factors that increase mortality in RA?
- Number of joints involved
- Extra-Articular manifestations
- Effects of disability/functional status
- Complications of treatment
- Increased CV risk
What is the pathogenesis of RA?
- Immune Response
- Release of Proimflammatory Cytokines
- Synovial Proliferation
- Neutrophils
What are the steps of the pathogenesis of RA?
Neutrophils activate chondrocytes that lead to cytokines such as TNF or interleukins to be released that cause the damage of the cartilage
What is Rheumatoid Factor RF?
- Antibodies that bind the Fc portion of IgG
- Participate in inflammatory response
RF is associated with what in RA?
More severe disease
What is the Classification Criteria for RA?
- Patients with > 1 swollen joint
- Points assigned in 4 categories
- Score > 6 classifies patient as having definite RA
What are the physical examination observations seen in RA?
- Chronic, inflammatory, symmetrical
- Characteristic joint distribution
- Fatigue
- Morning stiffness for MORE than >1 hr
Is low back pain observed in RA usually?
NO
What are the EARLY Joint Changes in RA?
Active inflammation with fast tissue swelling and effusion
What are the LATER Joint Changes in RA?
- Swan Neck Deformity
- Boutonniere Deformity
- Ulnar Deviation at MCPs
- Subluxation
What are the Risk Factors for Severity of RA?
- More involved joints
- Positive rheumatoid factor and anti-CPP
- Erosions by X-Ray
- Double HLA-DR4
What is anti-CCP and how does it compare to RF?
Cyclic Citrullinated Peptide
Higher specificity but lower sensitivity for RA
Can anti-CCP be positive when RF is negative?
YES, both lab values are needed in early disease determination
What are laboratory test values that are observed in RA?
- ESR
- C-Reactive Protein
Is ESR and CRP high or low in RA?
High, reflects acute phase and inflammatory responses
What increases within inflammation in RA and is reflected in serum viscosity?
Fibrinogen
Albumin and Globulins are reflected how in RA?
Albumin = decreased
Globulin = increased
What is seen on X-Rays with Early RA?
Soft tissue swelling, juxtaposition-articular demineralization
What is seen on X-Rays with Late RA?
Secondary osteoarthritis, joint space narrowing
What is the most common disease course of RA?
Chronic inflammation with exacerbations and remissions
For the onset of OA and RA, which one is seen earlier?
RA
