Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHA223 > Rheumatiod Arthritis 1 (SD) > Flashcards

Rheumatiod Arthritis 1 (SD) Flashcards

1
Q

What type of disorder is RA?

A

chronic autoimmune inflammatory disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where does RA occur?

A

within synovial joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

symptoms of RA

A

pain
swelling
stiffness
joint erosion and destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What other places does RA affect? (inflammation elsewhere)

A 
blood vessels
bone marrow
GI tract
lungs
eyes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes mortality with RA?

A

cardiovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is symptom onset of RA?

A

> 25 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

male:female

A

1:2.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

swelling

A

synovial tissue in caps of joints becomes damaged causing tissue to thicken and swell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

stiffness

A

inflammed joints stiffen and are difficult to move correctly
especially in mornings or after long rest
can last for hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pain

A

cartilage and bone within the joints will wear down over time
muscles, ligaments and tendons weaken and no longer stabilise joints
causes intense pain and joint damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

redness

A

joints can be warm

may appear pink/red on the outside during flare/when inflammed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 bones in the finger called?

A

distal phalanx
middle phalanx
proximal phalanx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 3 joints in the fingers called?

A

distal interphalangeal joint - DIP
proximal interphalangeal joint - PIP
metacarpophalangeal joint - MCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

symptoms in early stage RA

A

ulnar deviation - hand less straight, inflammation in metacarpal region
boutonniere deformity - DIP hyperextended and PIP flexed (bend)
swan-neck deformity - DIP flexed and PIP hyperextended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

healthy bone/joint

A

articular cartilage provides a lubricated surface for the opposing bones
synovial membrane produces/contains synovial fluid
synovial fluid provides lubrication and removes debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are autoantigens?

A

antigens produced by the body that are attacked by the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do autoantigens cause?

A

an immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What genes regulate the immune system?

A

human leukocyte antigen (HLA)

genes on chromosone 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are HLA genes part of?

A

MHC 1 and MHC 2 complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

at risk patients related to HLA genes

A

patients with alterations to HLA-DR1 and HLA-DR4 alleles at increased risk of RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mutation of what is involved in activation of inflammatory cells

A

PTP2N22 mutation
-> encodes the protein tyrosine phosphatase
involved in the activation and control of inflammatory cells, including T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is produced that is thought to be an environmental factor for RA?

A

environmental arthritogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What environmental factors may cause RA?

A 
viruses
gut bacteria
smoking
gum disease
obesity
diet
citrullinated proteins
-> lead to autoantigen generation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is citrullination?

A

citrullination is a post translational conversion of arginine to citrulline in proteins by an enzyme called PAD

-> Peptidyl Arginine Deminiase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

citrullination of proteins in RA

A
  • this becomes disregulated in RA
  • lead to alterations of proteins in the synovium
  • the protein AA sequence is changed
  • the immune system thinks this protein is not normal, thinks it’s a foreign protein
  • the immune system attacks these protiens
  • it can lead to autoantigens being formed which are then no longer recognised as self antigens by the immune system
  • anti-citrullinated protein antibodies (ACPA) are produced that attact these proteins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does periodontal infection/gum disease cause RA?

A

gum disease releases PAD enzymes at sites of infection
this causes citrullination of bacterial and human proteins
activates ACPA production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does smoking cause RA?

A

PAD is released from inflammation, apoptosis and necrosis in the lungs
citrullination of proteins
ACPA production

28
Q

What is MHC?

A

major histocompatibility complex

29
Q

What does MHC complex do?

A

binds antigens
presents antigens to T cells to activate the immune response
(destroyed)

30
Q

What does MHC contain that can cause RA?

A

HLA complex
HLA-DRbeta1 contains a binding site of the arthritogen that initiates the inflammatory synovitis
- alterations in genetics that cause RA

31
Q

What is synovitis?

A

inflammation of the synovial joint/fluid

32
Q

example of an auto-antigen

A

citrullinated protein

33
Q

What is activated when an auto-antigen is detected?

A 
T helper cells activated
they activate B cells
B cells produce antibodies
fibroblast like synoviocytes activated
macrophages activated
34
Q

Why do auto-antigens activate the cells of an immune response?

A

it thinks it’s a foreign body
doen’t know it’s our own cells
it it attacking it

35
Q

How does destruction occur?

A
  • T helper cells activate fibroblast like synoviocytes and macrophages
  • these activate osteoclasts, pannus, somatic mutations, proteases
36
Q

What are osteoclasts?

A

cells that break down bone

37
Q

What are cytokines?

A

small secreted proteins relesaed by cells that have a specific effect on the interaction and communications between cells
(cause a biological effect)

38
Q

What do cytokines bind to?

A

cytokine receptors

39
Q

What do cytokines regulate?

A

innate and adaptive immune system

process of inflammation

40
Q

Why do we block cytokines in RA?

A

to block the immune response/inflammation/RA

41
Q

autocrine cytokines

A

feed back onto themselves

42
Q

paracrine cytokines

A

affect nearby cells and activate them

43
Q

endocrine cytokines

A

released into the bloodstream, circulate and activate cells elsewhere

44
Q

main cytokines for RA

A

interleukins: IL-1, IL-6
interferons: INF-gamma
tumour necrosis factors: TNF-alpha

45
Q

antigen presentation

A
  1. antigen binds to APC (antigen presenting cell)
  2. APCs couple to T cells
  3. T cells release cytokines IFN gamma, IFN17
  4. T cells recruit macrophages and B cells
  5. macrophages release cytokines TNF-alpha, IL1, IL6
  6. T cells, macrophages, B cells attack the invader/bacteria and destroy it
  7. synovial cells release MMPs and RANKL
46
Q

What does an RA joint look like?

A
  • synovial membrane is inflammed
  • thick pannus
  • bone and cartilage is eroded
  • macrophages release cytokines (TNF alpha, IL1, IL6)
  • increased fibroblast like synoviocytes
  • macrophage like synovicytes (MLS) line the membrane
47
Q

another name for APC

A

dendritic cell

48
Q

What is a the pannus?

A 
inflammed synovial membrane
contains:
- osteoclasts
- macrophages
- T cells
- dendritic cells (APC)
- B cells
- leukocytes
- plasma cells
49
Q

What does IL-1 induce?

A

inflammation

50
Q

What does IL-6 stimulate?

A

osteoclast stimulation

51
Q

Where are fibroblast like synoviocytes located?

A

they line the RA joint

52
Q

Where are macrophage like synoviocytes located?

A

the line the membrane

53
Q

What do macrophage like synoviocytes (MLS) do?

A

proliferate in response to cytokines

produce RANKL

54
Q

What stimulates the release of fibroblast like synoviocytes (FLS)?

A

IL-1
TNF
(from macrophages)

55
Q

What doe FLS (fibroblast like synoviocytes) release?

A

cytoines

RANKL

56
Q

What does RANKL do?

A

stimulates osteoclasts which degrade bone

57
Q

What can the pannus lead to?

A

scar tissue
cartilage damage
bone erosion

58
Q

diagosis of RA

A
  • FH
  • pain Hx and examination of joints
  • blood tests
  • scans: x-rays, ultrasound, MRI (determines if RA is the cause of erosion)
59
Q

What blood tests are done to diagnose RA?

A

positive Rheumatoid Factor (RF)
positive anti-cyclic citrullinated peptide (anti-CCP)
high erythrocyte sedimentation rate (ESR)
positive c-reactive protein (CRP)

60
Q

How does RA decrease life expectancy?

A

decreases life expectancy by 3-7 years

61
Q

other problems caused by RA

A

heart disease
infection
GI bleeding

62
Q

factors for poor prognosis

A 
causasians
women
patients with subcutaneous nodules
advanced age at onet
inflammation >20 joints
early erosion
smoking
high ESR
high levels of RF
high anticyclic cirtullinated protein
63
Q

What causes other problems like CV/CNS/liver with RA

A

IL-6 that goes into the bloodstream

64
Q

CNS affects of RA

A

depression

fatigue

65
Q

CV affects of RA

A

accelerated CVD

increased myocardial electric instability

66
Q

affects on adipose tissue of RA

A

insulin resistance

67
Q

affects RA can have on the liver

A

anaemia

PHA223 (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions