RA - Pathogenesis + Dx workup

Question 1

The first change seen is rheumatoid ?, with a ?synovium showing a ? pattern and ? infiltration.

This leads to an exudative ? within the joint.
o This presents clinically as a ?, ? joint.

As the disease progresses, vascular granulation tissue (pannus: formed by
? and ?) grows from the peripheries ?,
destroying articular ?.

Answer 1

synovitis
swollen
villous
neutrophil
effusion
boggy
swollen
osteoclasts
macrophages
inwards
cartilage

Question 2

This inflammatory ? also causes focal destruction of bone, causing
‘?’ as seen on radiographs.
o Clinically this can lead to joint ?.
In long-standing disease, the ? cartilage may be destroyed and replaced by fibrous pannus, leading to secondary ? changes.

Morning stiffness in RA / the inflammatory arthropathies is thought to be either due
to the ? ? (abnormality seen in rheumacy), or the build up of ? ? during non-activity.

Answer 2

pannus
erosions
deformities
whole
osteoarthritic
cortisol trough
inflam mediators

Question 3

Dx
Bloods

o FBC: ? and ? in acute inflammatory phase,
? anaemia of chronic disease.
o ?/?: elevated in active disease.
o Rheumatoid Factor (RF): elevation in ?%, but non-specific.
o Anti-?: more specific, rises ? clinical disease by several ?
o ANA: if suspecting ? ?disease, however raised in 30%.
stands for -> • Anti-? ?.

Answer 3

leukocytosis
thrombocytosis
normocytic
esr/crp
70
ccp
predate
years
conn tiss
nuclear antibody

Question 4

Dx
XR

o Early findings: soft tissue ? around the ???Js and ???Js.
• ? usually spared (c.f. OA).
o Uniform joint ? ?
o Juxta-articular ?: can become more diffuse as disease progresses.
o Periarticular ?: form at extremities of the joint where the ? cartilage ends, as it is invaded by ?.
o ? / dislocation may also be seen.

Answer 4

swelling
pip + mcp
dipjs
space narrowing
osteopenia
erosions
hyaline
pannus
subluxation