RA/Gout Pathophysiology Flashcards
What is most common SYSTEMIC inflammatory disease?
RA
occurs at any age and in pts of all races
What is most important genetic component for RA?
rheumatoid factor
autoantibody
2 HLA types important for RA?
DR1, DR4
2 RA autoantibodies?
Rheumatoid factor (RF) anticitrullinated protein (ACPA)
4 steps of RA pathophysiology:
- genetic and environmental factors
- autoimmune destruction of synovium and connective tissue
- chronic inflammation of synovial tissue (pannus)
- erosion of bone surface/cartilage
What is 2nd step of RA pathophys?
autoimmune destruction of synovium and connective tissue
what is 3rd step of RA pathophys?
chronic inflammation of synovial tissue (pannus)
Which condition has symmetrical joint involvement?
RA
What type of anemia might be present with RA?
normocytic
Joint pain/stiffness > ___ weeks is symptom of RA.
6
Cardiac manifestation of RA?
pericarditis
What phenomenon is an extra-articular manifestation of RA?
Raynaud’s phenomenon
__ % of RA cases have rheumatoid nodules
20
4 pulmonary complications of RA?
- pleural effusions
- interstitial pneumonitis
- pulmonary fibrosis
- lung nodules
2 ocular/oral complications of RA?
- keratoconjunctivitis sicca
- Sjorgren’s syndrome
What syndrome involves splenomegaly and neutropenia that may be part of RA?
Felty’s syndrome
What is most important risk factor for gout?
elevated serum urate
Is RA more common in men or women?
women
Is gout more common in men or women?
men
Gout is an inflammatory joint disease due to deposition of what?
monosodium urate crystals
Hyperuricemia is the accumulation of uric acid in the blood to >= __mg/dL
6.8
Serum urate concentration levels > __mg/dL exceeds the solubility limit.
7
2 uric acid excretion sources
- urine (66%)
- GI tract (colonic bacteria)
Enzymes:
Increased activity of ___ and decreased activity of ___ can lead to uric acid production.
phosphoribosyl pyrophosphate synthetase (PRPPase), hypoxanthine-guanine phosphoribosyltransferase (HGPRTase)
Salicylates < __ g/day can cause hyperuricemia/gout
2
2 most important drug classes that can cause hyperuricemia/gout?
diuretics
cytotoxic drugs
Drugs that induce hyperuricemia and gout:
- diuretics
- salicylates (<2g/day)
- cyclosporine
- ethanol
- nicotinic acid
- cytotoxic drugs
- levodopa
- pyrazinamide
- ethambutol
4 parts of gout pathophys:
- imbalance between uric acid production/elimination
- accumulation of uric acid
- formation of crystals in joints and surrounding tissue
- acute inflammatory response - gout arthritis
2 laboratory findings with gout
- elevated serum uric acid
- leukocytosis
Which type of gout is associated with monoarticular arthritis?
“podagra” classic gout
which type of gout frequently attacks the first metatarsophalangeal joint?
“podagra” classic gout
joint is swollen and tender
Which type of gout chronic monosodium urate crystals deposit in soft tissues?
tophaceous gout
soft tissue damage, deformity, joint destruction, nerve compression syndromes (carpal tunnel
Which type of gout is similar to rheumatoid arthritis or osteoarthritis?
atypical gout
polyarthritis affecting any joint, upper or lower extremity
Which type of gout causes nephrolithiasis and acute/chronic renal impairment?
gouty nephropathy
