Pathophysiology of Rheumatoid Arthritis

Question 1

What is the specific gene in the genetic predisposition of RA?

Answer 1

HLA-DR4

Question 2

What is Rheumatoid Arthritis?

Answer 2

Unidentifiable etiologic factor, complex inflammatory response, with progressive activation of many cell types

Question 3

What is the mortality of RA?

Answer 3

Chronic disease, mortality increases with severity

Question 4

What are the factors that increase mortality in RA?

Answer 4

1. Number of joints involved
2. Extra-Articular manifestations
3. Effects of disability/functional status
4. Complications of treatment
5. Increased CV risk

Question 5

What is the pathogenesis of RA?

Answer 5

1. Immune Response
2. Release of Proimflammatory Cytokines
3. Synovial Proliferation
4. Neutrophils

Question 6

What are the steps of the pathogenesis of RA?

Answer 6

Neutrophils activate chondrocytes that lead to cytokines such as TNF or interleukins to be released that cause the damage of the cartilage

Question 7

What is Rheumatoid Factor RF?

Answer 7

1. Antibodies that bind the Fc portion of IgG
2. Participate in inflammatory response

Question 8

RF is associated with what in RA?

Answer 8

More severe disease

Question 9

What is the Classification Criteria for RA?

Answer 9

1. Patients with > 1 swollen joint
2. Points assigned in 4 categories
3. Score > 6 classifies patient as having definite RA

Question 10

What are the physical examination observations seen in RA?

Answer 10

1. Chronic, inflammatory, symmetrical
2. Characteristic joint distribution
3. Fatigue
4. Morning stiffness for MORE than >1 hr

Question 11

Is low back pain observed in RA usually?

Answer 11

NO

Question 12

What are the EARLY Joint Changes in RA?

Answer 12

Active inflammation with fast tissue swelling and effusion

Question 13

What are the LATER Joint Changes in RA?

Answer 13

1. Swan Neck Deformity
2. Boutonniere Deformity
3. Ulnar Deviation at MCPs
4. Subluxation

Question 14

What are the Risk Factors for Severity of RA?

Answer 14

1. More involved joints
2. Positive rheumatoid factor and anti-CPP
3. Erosions by X-Ray
4. Double HLA-DR4

Question 15

What is anti-CCP and how does it compare to RF?

Answer 15

Cyclic Citrullinated Peptide
Higher specificity but lower sensitivity for RA

Question 16

Can anti-CCP be positive when RF is negative?

Answer 16

YES, both lab values are needed in early disease determination

Question 17

What are laboratory test values that are observed in RA?

Answer 17

1. ESR
2. C-Reactive Protein

Question 18

Is ESR and CRP high or low in RA?

Answer 18

High, reflects acute phase and inflammatory responses

Question 19

What increases within inflammation in RA and is reflected in serum viscosity?

Answer 19

Fibrinogen

Question 20

Albumin and Globulins are reflected how in RA?

Answer 20

Albumin = decreased
Globulin = increased

Question 21

What is seen on X-Rays with Early RA?

Answer 21

Soft tissue swelling, juxtaposition-articular demineralization

Question 22

What is seen on X-Rays with Late RA?

Answer 22

Secondary osteoarthritis, joint space narrowing

Question 23

What is the most common disease course of RA?

Answer 23

Chronic inflammation with exacerbations and remissions

Question 24

For the onset of OA and RA, which one is seen earlier?

Answer 24

RA

Question 25

For the distribution of OA and RA, which one is symmetrical?

Answer 25

RA
OA is irregular

Question 26

For the location of OA and RA, which one is seen in DIP, PIP, and 1st CMC?

Answer 26

OA
RA: Wrists, MCP, PIP

Question 27

For morning stiffness, between OA and RA which one is prolonged greater than 1 hr?

Answer 27

RA

Question 28

For Inflammation, between OA and RA which one is prominent?

Answer 28

RA
OA: no inflammation

Question 29

For Nodules, between OA and RA which one has extra-articular nodes?

Answer 29

RA
OA: no

Question 30

For bone deformities between OA and RA which one has osteophyte formations?

Answer 30

OA
RA: erosions

Question 31

Between OA and RA which one has consistent lab findings and what are they?

Answer 31

RA: RF, anti-CCP, ESR, and CRP