Rheumatoid arthiritus

Question 1

Define rheumatoid arthiritus

Answer 1

Rheumatoid disease is a systemic autoimmune disease that particularly affects the joints, leading to arthritis
. • RA is a common and important cause of inflammatory joint disease. It is characterised by the presence of a circulating autoantibody, “rheumatoid factor”, which distinguishes this form of disease from several other inflammatory joint disease
. • The affected joints become swollen, painful and warm, often with redness of the overlying skin.

Question 2

Describe the 3 main pathological changes of RA

Answer 2

(A) - Rheumatoid Synovitis
- This is the early pathological change in which the synovium is swollen and shows a villous (think villi) pattern.
• There is a great increase in chronic inflammatory cells (mainly lymphocytes and plasma cells) in the synovial stroma, often with exudate comprising fluid, which produces effusion in the joint space.
• Fibrin is deposited on the synovial surface
. • Soft tissue swelling from synovial inflammation can be marked.

(B) - Articular Cartilage Destruction
• Vascular granulation tissue grows across the surface of the cartilage (pannus) from the edges of the joint, and the articular surface shows loss of cartilage beneath the extending panes, most marked at the joint margins.
• Synovial lining cells, normally 1-3 layers thick, undergo hyperplasia and form layers 8-10 cells deep

(C) - Focal Destruction of Bone 
• The inflammatory pannus causes focal destruction of the bone (pannus penetrates the subchondral bone)
. • At the edges of the joint there is osteolytic destruction of bone, responsible for ‘erosions’ seen on radiographs.
# • This phase is associated with joint deformity.

Question 3

Describe the use of radiography in RA diagnosis

Answer 3

The use of X-Rays and other imaging can help analyse deformities in the bones and synovial membranes. Notably, patients with RA have deformed ulnar deviation of the digits. Ultrasounds and MRI are not routinely required in patients with quite obvious clinical signs. Their main value is in patients with symptoms suggestive of an inflammator

Question 4

Describe the use of blood tests in RA diagnosis

Answer 4

Rheumatoid Factor - This is an autoantibody which binds to the Fc portion of the IgG antibody. RF and IgG join to form a complex which contribute to the disease process. Clinically the presence of RF is found in a blood test.
• Anti-CCP Antibodies (Cyclic Citrullinated Proteins) - Another type of autoantibody that is directed against attacking self proteins. Also clinically measured in a blood test.

Question 5

What is a DMARD

Answer 5

These are drugs used to achieve long-term control of RA activity and are recommended very early in the course of the disease to minimise later damage

Question 6

how do DMARDS work

Answer 6

This drugs exhibits its anti-inflammatory and immunoregulatory effects within cells by inhibiting several different enzymatic pathways, leading to decreased RNA & DNA synthesis. •

Question 7

give an example of a DMARD

Answer 7

methotrexate

Question 8

Define a corticosoid

Answer 8

These are potent anti-inflammatory agents that are effective at quickly controlling the pain, stiffness and the swelling of RA activity

Question 9

Define anti TNF therapy

Answer 9

TNF-α is an inflammatory cytokine which is present in excessive concentrations and is responsible for the destructive inflammatory processes that occur in articular cartilage and bone in RA. Anti-TNF drugs such as infliximab are usually used in combination with Methotrexate and these are considered the gold-standard treatment for severely active RA in patients who have inadequate response to DMARD treatment alone or NSAID

Question 10

Name some risk factors of RA

Answer 10

OBESITY, SMOKING, AGE, GENETICS, FEMALE