RA Flashcards
what hand joints are affected first in RA
MCPs and PIPs
where do you see lyphocytic infiltration in RA
synovium
which specific lymphocytes are most common in RA
TH17
does synovium have a basement membrane
no
what are most synoviocytes
fibroblast-like connective tisue cells
where is synovial membrane in the joint
at the sides, also continues straight into articular cartilage
what are the minority of synoviocytes
macrophage-like cells
describe normal synovial fluid appearance
acellular
straw coloured
what are the only cells which are normally, sparsely in synovial fluid
primarily neutrophils and a few macrophages
what are the 2 tests on synovial fluid? what do they suggest?
string test - string should be 4-6 cm
clot test - should be clear fluid, solid clot
which cells proliferate in RA in the synovium. What is the consequence
macrophage-like synoviocytes++ and fibroblast-like sunoviocytes creating many more layers of synovium than the normal 1-3
which inflammatory cells go where in RA
neutrophils - synovial fluid
lymphocytes - subintima
synovial joints have a rich network of what sort of capillafies
fenstrated
what is this sign of RA, what is it
Pannus, hyperplasia of synovial membrane creates kind of villi as the membrane folds on itself
what to type A cells differentiate into in active RA
they are similar to macrophages, so easily pushed into osteoclasts
MMPs are important/ What do they do?
Soften cartilage, gets eroded away, then bone is exposed leading to more erosion
Acpa antibodies activate osteoclasts. What il do they produce in RA
Il 18
What do th17 cells secrete in RA
Il 17
In RA, tnf, il1 and il6 cause rankl to be produced. That induces osteoclasts activity but what also happens with osteoblasts
Tnf etc activate dkk1 which induces sclerostin which inhibits osteoblasts
Ra. String test result
Short 1cm
%population RA in uk
1%
what are the 2 acute and 2 non-acute blood markers for RA
CRP/ESR actue
ACPA, RF non-acute
in the 2010 ACR/EULAR criteria
what constitutes an RA diagnosis
=/> 6 points
describe an overview of the 4 criteria for RA diagnosis in ACR/EULAR criteria
what is the crucial symptom in RA
one swollen small joint
RA disease tx always includes methotrexate but there are 3 different adjunct options for mild/moderate/severe disease. What are they
DMARD
TNF alpha inhibitor (infliximab)
Rituximab
DMARD and pregnancy
YES, monotherapy
pain tx for RA
NSAIDS and selective Cox-2 inh
methotrexate and pregnancy
NO
early DMARDS tx in RA improve two things but not the other. WHat are the three things
improve swollen joints, radiographic presentation
do not improve fatigue
which 2 enzymes does methotrextae inhibit
dihydrofolate reductase
thymidylate synthetase
2 monitoring blood tests when ongoing methotrexate tx
fbc lft
methotrexate inhibts which inflammatory cytokines
IL1 and NF-κB
specific HLAs with strong association to RA
HLA DR1 and DR4
Dmard 4 examples
Sulfasalazine
Methotrexate
Hydroxychloroquine
Leflunomide
what is the other tnf inhibitor that isn’t infliximab
etanercept
what drug is a tnf binder (not blocker)
adalimumab
name 3 Il1 inhibitors
Anakinra
Canakinumab
Rilonacept
RA drug that targets T cells
abaTacept
Tocilizumab inhibits..
Il6
