Pathophysiology of Rheumatoid Arthritis Exam 1 Flashcards

1
Q

What is the prevalence of RA?

A

1% of U.S. population but all populations affected

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2
Q

Who is susceptible to getting RA?

A
  • More common in women

* Most common age of onset: 40-60 y

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3
Q

relate mortality to RA

A

mortality is increased; correlates with severity as measured by number of joints involved, functional status, etc.

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4
Q

Etiologies of RA

A
  • Genetic predisposition: HLA-DR4
  • Unidentified etiologic agent: environmental such as virus or bacteria, periodontal disease, or smoking which initiates immune response
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5
Q

Pathogenesis of RA

A
  • Inflammatory response with progressive activation of many types of cells
  • Initial immune response followed by lymphocyte proliferation
  • Inflammation promoted by release of pro-inflammatory cytokines
  • Synovial proliferation follows
  • Neutrophils accumulate in synovial fluid, with activation of chondrocytes and initiation of enzyme degradation of cartilage
  • Invasion of cartilage
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6
Q

Remission criteria

A

Scoring ≤ 1 on all of the following

  • Tender joint count
  • Swollen joint count
  • CRP (in mg/dL)
  • Patient global assessment (0-10 scale)
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7
Q

ACR criteria for functional classes

A
  • Class I: Able to perform usual activities (self-sufficient)
  • Class II: Able to perform usual self-care and vocational activities, but limited in avocational activities
  • Class III: Able to perform usual self-care, but limited in vocational and avocational activities
  • Class IV: Limited in ability to perform usual self-care, vocational, and avocational activities
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8
Q

RA joint changes

A
  • Early: active inflammation with soft-tissue swelling and effusion
  • As inflammation continues, chronic damage to supporting soft-tissue structures leads to joint deformity including:
    • Swan-neck deformity (hyperextension at PIP, flexion at DIP)
    • Boutonniere deformity (flexion at PIP, extension at DIP)
    • Ulnar deviation (at MCPs)
    • Subluxation (partial dislocation) (MCPs and others)
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9
Q

Joint involvement

A
  • Wrists are very commonly involved, in contrast to OA
  • Any synovial joint may be involved
  • Low back pain is usually not caused by RA, but cervical spine involvement is common
  • In RA, involvement of PIPs and MCPs is more frequent than involvement of DIPs.
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10
Q

Extra-articular manifestations

A
  • Systemic symptoms (fever, malaise, weakness, myalgias, fatigue)
  • Rheumatoid nodules
  • Pleuro-pericardial disease (interstitial lung disease, pleural effusions, lung nodules, pericarditis)
  • Eye (involvement of the sclera [episcleritis, scleritis])
  • Sjögren syndrome (dry eyes and mouth)
  • Hematologic
  • Vasculitis
  • Cardiovascular disease
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11
Q

Disease course of RA (according to handout)

A

Most have chronic inflammation with relative exacerbations and remissions, but severity may vary

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12
Q

monitoring of RA disease activity

A
  • Erythrocyte sedimentation rate (ESR) is usually elevated in RA, reflecting acute phase response.
  • C-reactive protein (CRP) also reflects acute phase response (inflammation) and disease activity (does not always agree with ESR)
  • Serum viscosity and fibrinogen are other factors that rise in inflammation
  • Albumin falls with chronic inflammation; globulins are often high in RA
  • Platelets rise with inflammatory state, especially in juvenile idiopathic arthritis
  • Anemia of chronic disease is very common in active RA
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13
Q

Comparing RA and OA

A
  • Average age of onset for OA is older
  • RA is typically symmetrical in distribution of involvement
  • Frequency of involvement at specific sites (MCPs, PIPs, wrists in RA; DIPs, PIPs, 1st CMC in OA)
  • Duration and severity of morning stiffness (RA > OA)
  • Prominence of joint inflammation in RA; not in OA
  • Systemic or extra-articular symptoms in RA; not in OA
  • Bone erosions in RA; bony enlargement (osteophytes) in OA
  • RA with symmetrical joint space narrowing on x-ray vs. OA with sclerosis, osteophytes, and irregular narrowing.
  • RA with RF & anti-CCP, elevated ESR & CRP, other signs of chronic inflammatory condition; OA – no consistent lab findings
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