RHEUM REVIEW UNDERLINED TOPICS Flashcards
In which Rheumatologic disease does exercise pose NO risk, and may even be protective?
OA.
In Early OA, what happens to the number of metalloproteases present in cartilage?
Increases.
Although OA is a non-inflammatory disease, which inflammatory mediators are involved?
Prostaglandins Adipokines Nitric Oxide IL-1 Compliment Activation.
Dont PANIC with OA
Which Rheumatologic disease is characterized SYMMETRIC SYNOVITIS which can result in cartilage and bone destruction?
RA.
What is the shared epitope (in antigen binding grove) commonly involved in certain suptypes of RA? Name those subtypes.
QKRAA
HLA-DR4
HLA-DR1
QKRAA is commonly involved in subtypes HLA-DR_ and HLA-DR _ of _____________ disease
HLA-DR4
HLA-DR1
Rheumatoid Arth.
What is Rheumatoid factor (RF), how can it become pathogenic?
It is usually an IgM directed at Fc portion of an IgG.
May become pathogenic when complexed with IgG (RF-IgG)
What are the lymphocytes found in RA synovium?
CD4+ Tcells and TH17 cells
B-cells and plasma cells also present
NO PMNs
What is the purpose of CD4+ memory T cells in RA synovium?
Modulation and amplification of local immune response
What is the basic pathophysiology of gout?
Deposition of Monosodium Urate (MSU) crystals due to MSU SUPERSATURATION of extracellular fluids.
Hyperuricemia my be caused by two mechanisms. Name them. Which is most common in gout?
Over producers (10%) Under Excreters (90%)
Uric acid is formed in the breakdown of __________
pURInes.
What enzyme is responsible for oxidizing uric acid to allantoin in non-humans?
Uricase
Uric Acid overproducers usually inherit defects in ______ and ________ genes in an ___________ inheritance pattern.
PRPP synthetase
HGPRT
X-linked Recessive
In Uric Acid overproducers, which gene is associated with OVERACTIVITY of enzymes?
PRPP
lots of Purine metabolism; see the 3Ps
In Uric Acid overproducers, which gene is associated with a partial deficiency of an enzyme?
HGPRT
H could stand for HYPO activity maybe
What is the gold standard for diagnosing gout or crystal arthritis?
Arthrocentesis
Proteins coating gout crystals modulate the immune response. Early on, crystals are covered by ________, which _________ (promotes or inihbits) phagocytosis.
Crystals are covered by IgG, promoting phagocytosis
T/F Gout crystals are covered in IgG due to antigenic binding.
FALSE
Its due to charge interactions
Proteins coating gout crystals modulate the immune response. Later on in the disease process, crystals are covered by ________, which _________ (promotes or inihbits) phagocytosis.
Apolipoprotien B, inhibits phagocytosis
Which 3 findings are typical (according to the review) of a patient with Seronegative Spondyloarthritis?
- Sacroilitus and morning stiffness
- Enthesitis (swelling where tendons or ligaments insert into the bone)
- Inc Levels of TNF-alpha in synovium
What percent of people that are HLA-B27 positive get ankylosing Spondyloarthritis?
2%
What percent of people that are HLA-B27 positive and have a first degree relative with ankylosing Spondyloarthritis will get the disease?
20%
10 fold increase
Which disease is characterized by asymmetric, oligoarticular (few joints), arthritis in the lower extremities?
Reactive Arthritis
Reactive Arthritis is characterized by….
Asymetric, oligoarticular arthritis in the lower extremeties.
What is the basic pathogenesis of Systemic Lupus Erythmatosis (SLE)?
Misdirected recognition of self as foreign. (autoimmune)
Which Lymphocyte(s) is/are involved in SLE?
Both T and B cells.
Antibody responses toward autoantigens in SLE are ___________ and require _________ (cell)
Antigen Driven
CD4+ T cells
This means that we make selective autoantigens in lupus.
In SLE, loss of T-cell tolerance leads to…
peripheral autoreactive B-cell stimulation.
Is SLE a monogenic or polygenic disease?
Poly
Which Gene is MOST associated with SLE?
C4A
Although it is not specific to SLE, 95% of patients with SLE are ANA (+/-)?
ANA+
Antinuclear antibody
What are the targets of antibodies in lupus?
MULTIPLE NUCELAR ANTIGENS including:
- dsDNA
- Histones
- SSA, SSB, Smith and Ribonuclear Protein (non-DNA, non-histone antigens)
Anti-phospholipid antibodies in SLE type II cause _________ of platelets
Clotting
— Even though they are referred to Lupus Anticoagulant
What is the pathophysiology of Vasculitis?
Inflammation→ PAFs (platelet activating factors)→ ↑ VASCULAR PERMIABILITY→ Immune complex deposition.
Leads to palpable purpura
Because vasculitis is thought to be T cell dependent-mediated endothelial cell injury, this suggests that that the mechanism is most likely ___________.
Antigen driven
C-ANCA is generally associated with _______(protein) and ___________(disease)
Proteinase 3 (PR3)
GPA (Wegner’s disease or Granulomatosis with Polyangitis)
Remember that C’s affect your GPA
P-ANCA is generally associated with _______(protein) and ___________(disease)
MPO
Microsopic polyangitis (MPA)
MPA and MPO for P-ANCA
Polymyositis and Dermatomyositis are highly associated with
Interstitial Lung Disease (60%)
Polymyositis and Dermatomyositis have Anti-aminoacyl-tRNA synthetases. Where does this antibody target?
Cytoplasm
Anti-Jo-1 = anti-__________-tRNA synthetase
histayl
T/F Anti-synthetase antibodies are pathologic and myotoxic antibodies.
FALSE
They are neither pathologic nor myotoxic
Polymyositis is associated with CD____ cells
CD8+
think of polymyositis and Dermatomyositis. D comes before P and 4 before 8
Dermatomyositis is associated with CD____ cells
CD4+
(think of polymyositis and Dermatomyositis. D comes before P and 4 before 8)
