RA - Pathology/Aetiology Flashcards

1
Q

What guidelines do we use to classify RA?

A

2010 EULAR/ACR Classification (European Leaque against Rheumatism/American College of Rheumatology)

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2
Q

What criteria do we use to classify the types/levels of RA?

A

Under the 2010 EULAR/ACR Classification its done by:

  • No./size of joints involved
  • Serology (-ve/low +ve or high +ve tests for RF & ACPA)
  • Acute Phase Reactants (ESR/CRP)
  • Duration (>6wks of symptoms)
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3
Q

Who gets RA?

A

3x more common in women

Can occur at any point after 16yrs but mostly in 4th/5th decade

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4
Q

What factors contribute to Development of RA?

A
Genetics
Environmental:
- Certain infections
- Silica Exposure
- Smoking
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5
Q

What infections predispose to RA?

A
Viruses e.g. CMV/EBV
E. Coli
Mycoplasma
Periodontal Disease (Porphyromonas Gingivalis)
Gut Microbes
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6
Q

In short how does RA work?

A

repeated insults to the synovium in genetically predisposed patients leads to immune complex & ACPA/RF production –> Chronic inflammation + Neovascularisation of the synovium

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7
Q

What do we call the fibrovascular tissue that forms over the hyperplastic intimal lining?

A

Pannus

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8
Q

What cell types are involved in Rheumatoid Synovitis?

A

T Cells
B Cells
Macrophages
Fibroblasts

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9
Q

What major inflammatory mediators are involved in Rheumatoid Synovitis?

A

ACPA (anti-citrullinated Protein Antibodies)
Rheumatoid Factor

TNF-Alpha
IL-6
IL-17
IFN-gamma

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10
Q

What inflammatory cell predominates in the synovial fluid ?

A

Neutrophils

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11
Q

How is cartilage damaged during RA?

A

Synovial fibroblasts from the intimal layer invade the articular cartilage & produce several classes of proteases (E.g. Metalloproteinases) that break down cartilage matrix allowing it to wear down under mechanical pressures

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12
Q

How is bone damaged during RA?

A

RANKL produced by Synovial Fibroblasts and macrophages activate osteoclasts

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13
Q

How does RA affect CVD?

A

Altered Lipid Metabolism –> Increased coronary artery disease

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14
Q

How does fatigue & Reduced cognitive function come about from RA?

A

Dysregulates the HPA (Hypothalamic-Pituitary-Adrenal) Axis

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15
Q

How does RA affect the liver?

A

Elevated Acute-phase response

Also IL-6 increases Hepcidin hormone production –> Iron dysregulation –> Anaemia

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16
Q

How does RA affect he lungs?

A

Fibrosis and Interstitial Lung Disease (ILD)

17
Q

How does RA affect the muscles and bone?

A

Sarcopenia and Osteoporosis can occur

18
Q

What are some other consequences of RA on the rest of the body?

A

Secondary Sjogren Syndrome

Also Chronic Inflammation leads to:

  • Vasculitis
  • Nodules
  • Scleritis
  • Amyloidosis