Rheumatoid Flashcards
T/F: Acute Rheumatic diseases are often spontaneously initiated
False
They are typically onset from an outside force like infection, medications, or exposure
Are acute rheumatic diseases typically self-limiting?
Yes
Chronic rheumatic disease typically occurs as a result of what?
An autoimmune response
Once a disease establishes flares of chronic rheumatic disease, those flares become _________ (less frequent/more frequent)
What is this a result of?
More Frequent
Likely the result of immune system memory
How is the endothelium involved in the initiation of a rheumatic response?
What happens to neutrophils and monocytes during this time?
Regional Blood vessel endothelium is activation by pro-inflammatory cytokines
The endothelium expresses ligands (attachment sites) for inflamatory cell markers (integrins) which allow neutrophils and monocytes to preform diapedesis into the underlying tissues
Antibody-antigen complexes are _________ (activators/deactivators) of the complement cascade
Activators
When the complement cascade is activated……
It ________ (attracts/repels) additional imflammatory cells
It ________ (Increases/Decreases) cell permeability which ________ (Increases/Decreases) inflammation
Attracts
Increases
Increases
Helper T1 cells activate _________ which increase __________
Macrophages
Phagocytosis
Helper T2 cells activate ________ which increases what?
B-Cells
Increases Antibody Production
Helper T-17 cells activate __________ and ________ ________
Granulocytes
Autoimmune Mechanisms
T/F: In some tissues, cells that ordinarily are unrelated to the immune response can alter their form and function to become part of a chronic inflammatory response.
True
What condition involves crystal induced inflammation in synovial joints?
Gout
What crystals are typically responsible for gout?
Monosodium urate
What joints does gout primarily effect?
Great Toe
Midfoot
Ankle
Knee
What is the name for the collections of urate crystals that collect in joint spaces in gout?
Tophi
What are TWO common ways people develop gout and hyperuricemia?
Under Excretion (90%) Over Production (10%)
Only about ___% of people with hyperuricemia will develop gout
10%
What increases your risk for developing gout?
Metabolic Syndrome High-Purine Diet Obesity Renal Disease Heart Disease
How does a patient develop a gout ‘flare’?
- Uric acid crystals precipitate in a joint
- IL-1 and TNF activate the endothelium and inflammatory mediator come into the joint
- Complement gets activated leading to more inflammation
- Inflammation builds even more with phagocytosis, degranulation, free radical release/damage, and protein destruction with proteinases
What medications can reduce joint inflammation in gout flares?
NSAIDs
Steroids
Colchicine
What are THREE ‘lifestyle’ changes that can prevent future gout attacks?
Loss Weight
Decrease Protein in diet
Control Co-morbid conditions (HTN, BP, Met-S)
How does colchicine work in gout?
It is a microtubule poison, so WBC can not squeeze through the small endothelial spaces into joints and produce inflammation
Which rheumatic disease is characterized by joint inflammation, pain, and swelling, with a prevalence for joint destruction, a higher mortality, and an unknown trigger?
Women are more effected by this than men by a 3:1 ratio
Rheumatic Arthritis
What are the THREE most common joints effected by RA?
Wrist
MCP
MTP
A _________ is a membrane of granulation tissue made of mesenchyme and bone-marrow derived cells that forms in the joints during chronic RA.
This stimulates the release of what?
Pannus
This stimulates the release of cytokines (ex: IL-1, Prostagladins, Substance P) by macrophages leading to cartalige destruction and bone erosion
What is the most sensitive antibody test for RA?
Anti-CCP
Which antibody is present in about 50% of RA patients?
Rheumatoid Factor (RF)
Which gene is associated with Anti-CCP and RA?
What lifestyle habit is also associated with the above two things?
HLA-DRB1
Smoking
T/F: There is a foolproof blood test to diagnosis RA
False
There is not
What are extra-articular manifestations of RA?
Sicca Syndrome (Sjogren's) Pericarditis Pleuritis Pulmonary Fibrosis Ocular Inflammation Neuropathies Vasculitis
Methotrexate is an inhibitor of what?
Dihydrofolate Reductase (DHFR)
Inhibits the creation of new DNA and lowers the number of inflammatory cells that exist
Methotrexate __________ (increases/decreases) apoptosis of T-Cells
Increases
How does Methotrexate alter the endothelial cascade?
Decreases attachment site for WBCs thus decreasing diapedesis
What disease is described as a degenerative disease of joint cartilage and the bone beneath it?
Osteoarthritis
Osteoarthritis involves the degradation of a certain protein in cartilage…..
What is the name of this protein?
Proteoglycans
In what type of joints does osteoarthritis tend to be worse in?
Weight Bearing Joints
Work-Stressed Joints
A key feature of osteoarthritis is the formation new bony outgrowths called what?
Osteophytes (Bone Spurs)
Osteoarthritis can be confirmed using what imaging modality?
What are some findings that would be consistent with that Dx?
XR
Jointspace narrowing
Increased bone formation around the joint
Subchondral cystformation
Osteophytes
What is the name of the rheumatic disease that primarily effects the spine?
Ankylosing Spondylitis
What portions of the spine are primarily effected in ankylosing spondylitis?
The Ligaments and Joints of the spine become inflamed leading to stiffness
Can the joints and bones become fused together in ankylosing spondylitis?
Yes
Other than a H&P and XR, what gene is present in Ankylosing Spondylitis that is helpful with diagnosis?
HLA-B27
What DMARD can be used in ankylosing spondylitis?
What NSAID?
DMARD: Sulfasalazine
NSAID: Indomethacin
Are men or women more likely to develop SLE?
Is it more prevelant in afirican americans of caucasians?
Women
African Americans
What is the ‘common thread’ in SLE?
Defect in the suppression of the complement cascade
This leads to recurring inflammation due to the inability to break down apoptotic cells
To be diagnosed with SLE, patients need to have __ of the ___ criteria present either serially or simultaneously
4 of the 11 criteria
What is the most common presenting symptoms in lupus?
This is prevalent in about 85%of cases
Malar Rash
Which rash associated with SLE can be disfiguring?
Discoid Rash (Scarring)
Patients with SLE can have _________ (Painful/Painless) oral ulcers
Painless
Polyarthritis occurs in ___% of SLE patients
While joint deformities occur in __% of SLE patients
90%
10%
What are pulmonary manifestations of SLE?
Pleuritis (If mild treat with NSAIDS)
Serositis (interstitial inflammation, can lead to pulmonary fibrosis)
PTX
Pulmonary HTN
What is a renal manifestation of SLE?
This is commonly seen with proteinuria
Nephritis
What are examples of neurological manifestations of lupus?
Neuropathy Memory Impairment Headache Seizures Pychosis
SLE patients (especially women under 45) have a 50x increased risk for what?
TIA
CVA
Which antibody is positive in 95% of SLE cases but is NOT specific to SLE?
+ ANA
Which antibody is very specific to SLE?
Anti-dsDNA IgG
Which antibody is only present in 25% of SLE cases?
Antu-Sm
Which antibody is not very specific to SLE but can be helpful in identifying those with an increased clotting risk?
APLA
Which medication class is commonly used to control pain and swelling in SLE patients?
Although it can put SLE patients at an increased risk for what?
NSAIDs
This can lead to an increased risk for aseptic meningitis in SLE patients
Which antimalarial is often used in SLE?
Hydroxycholoroquine
What medication class is used to rapidly suppress inflammation in SLE flares?
Corticosteroids:
Prednisone
Hydrocortisone
Methylprednisolone
Dexamethasone
What medication class is reserved for SLE patietns with CNS and renal involvement?
Immunosuppressants:
Methotrexate
Cyclosporine (can lead to more kidney damage)
Cellcept
Imuran
