RA Flashcards
causes of premature mortality in RA
infection, bleeding, CVD, lymphoproliferative dz
indicators of severity of dz
number of joints involved, presence of RF and anti-CCP
what happens in the joint of RA
synovium becomes pannus. membrane hyperplasia, cellular infiltration (lymphocyte clustering) of subintima, neoangiogenesis, villous projections, marginal erosions
basic equation for RA
genetic susceptibility + trigger = RA
shared epitope hypothesis
over-representation of AA sequence on HLA DR4 and DR1. Results in increased susceptibility to RA
PADI
peptidylarginine deiminases; convert arg to citrulline allowing protein to interact with SE affected binding site and present to T cells
environmental triggers of RA
cigarette smoking (increased inflammation leading to peptide citrullination
symptoms of RA
insidious, symmetric, polyarthritis (>3 joints). morning stiffness >1 hr
Signs of RA
Swan neck, boutonniere, ulnar deviation
what joints are involved and not involved?
entire wrist, MCP, PIP (not DIP of fingers), not thoracolumbar spine
extra articular manifestations
nodules on tendons, pulmonary, CV, eye problems (scleritis)
radiographic features
diffuse (OA-assymetric) narrowing of joint space. Soft tissue swelling. Marginal erosion. Subluxation and ulnar deviation
Spine involvement
atlantoaxial subluxation
Lab findings
anemia, thrombocytosis, RF, anti-CCP, ANA
RF
autoantibodies specific for Fc fragment of IgG. Higher titer=poor prognosis, low specificity.
