RA Flashcards
who has a higher risk of developing RA?
- HLA-DR4+
- women (esp 50-70s)
- twins and first degree relatives of affected
what is a systemic rheumatic disease?
affect whole person, complaint in joint and muscle (RA and SLE)
what are the potential causes of arthralgia?
viral illness, overuse, exercise, ligament laxity
how does DC contribute to initiation and propagating RA?
present self-Ag to T cells (activated via TLRs by pathogens)
what are the roles of B cells in RA pathogenesis?
- Ag presentation/T cell activation
- autoAb production
- cytokine production
what are the positive and negative roles of fibroblast?
positive: produce hylauronan (part of joint fluid)
negative: produce metalloproteinases (breakdown ECM)
which autoAbs can trigger RA?
collagen II, proteoglycans, chondrocytes, IgG
what is the most common form of polyarthritis?
RA
what are the Old criteria for RA classification?
- morning stiffness >1hr
- arthritis in >3 joints
- arthritis in hand joints (PIP, MCP, wrist)
- symmetric arthritis
- RF, nodules
- XR changes, erosion
need 4/7 for classification, #1-4 must be present for 6 wks
the american college of rheumatology requires___criteria to classify RA
T/F: the same number is needed to Dx RA to start Tx
6/10
False
what are the features of stage 1 RA?
Ag presentation to T/B cells, no Sx
what are the features of stage 2 RA?
T/B proliferate, cytokine release, angiogenesis
clinically unwell, joint pain/swelling/tender
high ESR/CRP, soft tissue swelling on XR
what are the features of stage 3 RA?
synovial hypertrophy w cell accumulation in joint space
joint pain/swelling, malaise, low energy
soft tissue/joint swelling, low ROM, nodules
what are the features of stage 4 RA?
pannus joint invasion, enzymatic damage to cartilage
like stage 3 but w increased function loss, early deformity in joints, nodules
osteopenia on XR, pannus on MRI
what are the features of stage 5 RA?
bone erosion, cartilage loss, ligament damage
joint pain, swelling, loss of function, deformity
swollen joints, contracture deformity, nodules, systemic manifestation
joint space narrowing and erosion on XR
what is the most common arthritis affecting the big toe?
OA
fever and poor appetite in RA are the effects of:
TNF
what vascular issue impacts the small vessels in RA?
atherosclerosis
what are the Sx of vasculitis?
skin-ulcers/gangrene
bowels-perforation/gangrene
nerve-mononeuritis
eye-scleritis/episcleritis
where are RA nodules likely to occur?
- skin (achilles, pulp of digits–>where there is pressure)
- tendon
- lung, heart, brain, eye
which systems are affected by RA?
vascular, resp, CV, neuro
what therapy is used in nerve compressions in RA?
TNFi
what extra-articular syndromes are associated with RA?
Sjogren’s (dry eyes/mouth/lung/vagina)
Felty’s (RA, splenomegaly, granulocytopenia)
anemia/osteoporosis
Describe the functional classifications of RA:
C1-can self care, vocation, rec
C2-can self care and vocation, limited rec
C3-unable to do daily activities w comfort
C4-needs assistant with everything, stays in bed
what factors lead to poor prognosis in RA?
greater disease load, RF+, anti-CCP/HLA-DR4+, erosion on XR
does RF in serum make a Dx of RA?
no
which autoAb is involved in RA?
IgM-Ab
which autoAb is involved in SLE?
DNA-Ab
synoviocytes include:
macrophage and fibroblasts in intimal layer of synovium
