Rheumatoid Arthritis

Question 1

• Chronic autoimmune, inflammatory disease
• synovial tissue is inflamed and locally destructive
• systemic disease affecting mainly joints but also: skin, eyes, heart, lungs, nerves
• increased mortality
• 2-3 times more common in women
• can start at any age
• often remission during pregnancy

Answer 1

Rheumatoid arthritis

Question 2

pathogenic factors for rheumatoid arthritis

Answer 2

hormonal factors

• 2-3 times more common in women

cigarette smoking

• increases the risk of the disease in women, increases severity of the disese, reduces the response to some medication, increassed citrullination of peptides

Environmental factors

Infections

• oral bacteria- gingivitis
• epstein barr viral
• abnormal response to normal microbes

Question 3

• autoantibody against the Fc portion of IgG
• found in 75-80% of patients with RA
• high titer is associated with: Severe disease, erosions, nodules, extra-articular manifestations
• not specific for RA- other autoimmune disease (sjogren syndrome) or infections like endocarditis, malaria, hep c, COVID
• part of normal immune response- normal “amplifying autoantibody that helps to clear antigens”

Answer 3

Rheumatoid factor

Question 4

• > 30 years old
• fingers (DIP,PIP, CMC-1) A/C, spine, hips, knees, MTP1
• slow onset
• no systemic symptoms
• joint exam- hypertrophic bone formation
• can have joint infusions
• some synovial thickening
• x-ray will have joint space narrowing, osteophytes
• labs- useless

Answer 4

Osteoarthrits

Question 5

• Can happen at any age
• affects most joints,often small joints of fingers and toes. symmetric
• rare: DIP, T/L, spine, hips
• often sudden
• common
• joint exam would show swelling, deformitis
• joint erosions
• synovial thickening
• x-ray will show erosiions
• labs often helpful

Answer 5

Rheumatoid arthritis

Question 6

Lab tests to monitor RA activity

Answer 6

Erythrocyte sedimentation rate

• the rate at which red cells fall in plasma
• indirect measure of inflammation
• affected by: red blood cell number, size and shape, fribrongen, immunoglobulins

C-reactive protein

• C= capsule
• pattern recognition receptor
• not dependent on red cell number
• made in the liver
• induced by II-6
• can be done on stored serum

CRP and ESR correlate with joint damage (erosions)
CCP antibodies but not RF may correlate with disease activity

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Question 7

Causes of mortality in patients with rheumatoid arthritis

Answer 7

• coronary artery disease risk: follows severity of inflammation, relative risk is similar to diabetes or perhaps higher
• non-hodgkins lymphoma: follows severity of inflammation
• systemic manifestations of rheumatoid arthritis: interstitial lung disease
• side effects from medications: infections (immunosuppressive medications) gastrointestinal bleeding (NSAIDs)