Prof Neil McHugh RA Flashcards
Autoimmune disease occur when there is dysregulation of the immune system with loss of ___-_____.
Self-tolerance
List some clinical symptoms common to all autoimmune Rheumatic diseases (6)
1) Malaise (general discomfort/unease)
2) Weight loss
3) Arthritis
4) Anaemia of chronic disease
5) Myalgia (pain in muscle)
6) Fatigue
RA is based upon the presence of _____ in at least one joint, the absence of an alternative diagnosis better explaining the ___ and achievement of a total score of at least _ (of a possible 10) on the ACR for Classification of RA
Synovitis
6
BSR (British Society for Rheumatology) diagnosis of RA states that persistent joint inflammation affecting at least _ joint areas, involvement of the meta___pop______ or meta____sop_____ joints or early morning stiffness of at least __ min duration.
3
metacarpophalangeal
metatarsophalangeal
30
RA increases with age until approx __ years of age and decreases thereafter.
75
What predisposing factors are associated with RA?
- ______ (virus, bacterium, smoking, periodontitis)
- Genetic (___-DRB1) - MHC Class II gene
- Hormones or hormonal deficiencies e.g more females with RA than males and disease subsides during _____
Environmental
HLA-DRB1 gene (HLA-DR4)
Pregnancy
Autoantibodies in RA:
RF (______ ____)
- Antibodies to Fc domain of Ig_
ACPA (Anti-______ protein _____)
Rheumatoid factor
IgG
Anti-Citrullinated protein antigen
Citrulline is a ____-______ modification of arginine
Post-translational modification
ACPA can be found up to __ years before onset of symptoms in RA
14 years
ACPA (Anti-citrullinated protein antibodies) predict ____ and _____ disease
Erosive and Progressive
In RA is there symmetrical or asymmetrical swelling in small joints?
Symmetrical
Lumps on the knuckles of a RA patients are called what?
Rheumatoid nodules
Due to inflammation of the ocular tissues, RA patients are more susceptible to WHAT?
Scleritis/episcleritis
What is periarticular osteopenia?
- Bone loss/thinning around joints
DAS28 (___ ____ ____ 28) looks at the total number of swollen/painful joints and levels of ESR and ___ and patient score.
The DAS28 score proves a number on a scale from 0 - __ which indicates current activity of the disease.
Disease Activity Score 28
CRP (C reactive protein)
10
What does the HAQDI stand for?
It looks at how well patients can perform various actuates e.g grooming, moving, walking, grip etc…
- Health assessment questionnaire
Give an example of a common glucocorticoid that is often given to patients with RA either orally or as a local injection.
Prednisolone
Rituximab is a B cell depleting monoclonal anti-CD__ antibody.
Complement mediated cell lysis and _ cell apoptosis
anti-CD20
B - cell apoptosis
Abatacept is a soluble receptor composed of CTLA-_ and Fc fragment of IgG.
It blocks the interaction of CD80 and CD86 with CD28 on _ cells.
CTLA-4
T
