Rheumatoid Arthritis Flashcards
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disease characterised by an inflammation of the synovial joints leading to joint and periarticular tissue destruction. Does RA affect men or women more?
- women
- 3:1
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disease characterised by an inflammation of the synovial joints leading to joint and periarticular tissue destruction. What % of RA has been associated with genetic susceptabilty?
1 - 5%
2 - 20%
3 - 30%
4 - 50%
3 - 30%
RA is a breakdown in immunological tolerance. What does immunological tolerance mean?
1 - body produces immune response against self antigens
2 - bodies ability not to initiate an immune response against self-antigens
3 - bodies produces abnormal antibodies causing excessive secretion of IgE
4 - all of the above
- 2 - bodies ability not to initiate an immune response against self-antigens
- breakdown in immune tolerance means the immune system could react against self antigens
What are cytokines?
1 - signalling proteins
2 - immune cells
3 - growth factors
1 - signalling proteins
- able to activate immune system
Cytokines are cell signalling proteins that are able to activate the immune system. There are pro and anti-inflammatory cytokines. In RA what are the key pro-inflammatory interleukins that we need to be aware of?
1 - IL-6, IL-1, IL-4 and TGF-B
2 - IL-1. TNF-a, IL-13, IL-6
3 - IL-6, IL-1, IL-4 and TGF-B
4 - IL-6, IL-1, TNF-a and IL-17
4 - IL-6, IL-1, TNF-a and IL-17
Cytokines are cell signalling proteins that are able to activate the immune system. There are pro and anti-inflammatory cytokines. If there is an imbalance between pro and anti-inflammatory cytokines, is this good or bad?
- bad
- pro-inflammatory cytokines can dominate
- in RA pro-inflammatory cytokines can dominate causing information
What is the innate immune system?
- 1st line non-specific immune system
- the skin is an example of this
The innate immune system is the 1st line defence. In RA what is the cell of the innate immune system that has been identified as a key effector?
1 - platelet
2 - mast cell
3 - macrophage
4 - natural killer cell
3 - macrophage
The innate immune system is the 1st line defence. In RA macrophages are a cell of the innate immune system that has been identified as a key effector. Macrophages are able to phagocytose antigens and trigger an immune response through antigen presentation. What pro-inflammatory cytokines are macrophages able to produce?
1 - IL-1, IL-6 and TNF-a
2 - IL-6, TNF-a and TGF-B
3 - IL-1, IL14 and TNF-a
4 - IL-6, IL-14 and TNF-a
1 - IL-1, IL-6 and TNF-a
A number of therapies in RA target macrophage number. What does the level of macrophage relate to in terms of treatments?
1 - disease severity
2 - treatment response
3 - prescience of disease but not severity
2- treatment response
- this drives clinical outcomes
What are the 2 key cells of the adaptive/specific immune system?
1 - T cells and macrophages
2 - T and B cells
3 - NK and neutrophils
3 - B cells and macrophages
2 - T and B cells
T cells are part of the adaptive/specific immune system. What type of T cell has been identified to be raised within synovium and able to activate osteoclasts, favouring cartilage reabsorption?
1 - Th-17
2 - Th- 4
3 - Th-10
4 - Th- 2
1 - Th-17
Which cell of the immune system is able to produce antibodies?
1 - monocytes
2 - T cells
3 - macrophages
4 - B cells
4 - B cells
Erythrocyte sedimentation rate (ESR) is the time it takes for RBCs to fall to the bottom of a sample tube. ESR can be used to detect the presence of inflammation. If inflammation is high would we expect the ESR to be high or low?
- low, which means RBCs fall quickly
- a faster ESR indicates inflammation as inflammatory markers bind to RBCs and make cells heavier
What is C reactive protein?
1 - protein signalling molecule
2 - inflammation inducing protein
3 - pattern recognition receptor (opsonin)
4 - pattern associated molecular receptor
3 - pattern recognition receptor (opsonin)
- specifically it is classed as a pentraxin produced by hepatocytes during inflammation
- released by the liver in response to IL-6
C reactive protein (CRP) are pentraxins which are classed as opsonins released by the liver in response to IL-6 and inflammation. What is the function of CRP?
1 - binds to pathogens and dying/dead cells
2 - accentuates phagocytosis
3 - activates the complement pathway
4 - all of the above
4 - all of the above
C reactive protein (CRP) are pentraxins which are classed as opsonins released by the liver in response to IL-6 and inflammation. CRP is able to bind pathogens and dying/dead cells, accentuating phagocytosis and activating the complement pathway. How does it bind to phagocytic cells and the complement system?
1 - Fc receptors
2 - Fab regions of antibodies
3 - hinge junction of antibodies
4 - Fab receptors
1 - Fc receptors
What are autoantibodies?
- antibodies that target our own cells
Auto-antibodies are antibodies that react against self antigens due to a breakdown in immunological tolerance. What are the 2 autoantibodies that can be measured to detect the risk of RA?
1 - RF and anti Cyclic citrullinated peptide (anti-CCP)
2 - IL-6 and Cyclic citrullinated peptide (anti-CCP)
3 - RF and CRP
4 - RF and FGF-B
1 - RF and Cyclic citrullinated peptide (anti-CCP)
Rheumatoid factor (RF) is an autoantibody, antibodies that target our own cells in the body. RF is able to bind with what portion of other antibodies, mainly IgG and IgM?
1 - hinge region
2 - Fc portion
3 - Fab portion
4 - antigen binding site
2 - Fc portion
- fab région wil bind with antigens
When RF autoantibodies are present they bind with the Fc portion of IgG and IgM antibodies and form what?
1 - antigen-immunoglobulin complex
2 - immune complexes
3 - B cell activated complexes
4 - T cell activated complexes
2 - immune complexes
- these can then go on to clump together and damage tissue
What % of patients with RA have elevated levels of RF?
1 - 10%
2 - 40%
3 - 60%
4 - 100%
3 - 60%
What is the specificity, the ability of a test to correctly identify people without the disease of RF in RA and is RF specific to RA?
1 - 100%
2 - 86%
3 - 55%
4 - 45%
2 - 86%
- can be present in other autoimmune diseases and healthy patients, so not specific to RA