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Week 2 - Inflammation and Infection > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

what is a normal immune response?

A

acute and chronic response
resolution

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2
Q

what are the potential problems associated with the immune response?

A

-bystander damage
-non resolution
-self-recognition and attack

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3
Q

what is autoimmunity?

A

loss of immunological tolerance to self

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4
Q

what is tolerance?

A

controlled unresponsiveness to self (despite the capacity to do so)

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5
Q

how common are autoimmune diseases?

A

5% of population, 1 in 20

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6
Q

what are the various meachanisms that result in autoimmunity?

A

-dysfunction in tolerance
-presentation of self antigens
-molecular mimicry
-loss of regulatory mechanisms

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7
Q

how many hits generally do we need to develop autoimmunity?

A

2 hit hypothesis

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8
Q

what are the effects of endocrine cells autoimmunity?

A

diabetes, hyperthyroidism, Addisons disease and premature ovarian failure

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9
Q

what is. the effect of autoimmunity on the liver?

A

autoimmune hepatitis, primary biliary cirrhosis

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10
Q

what is the effect of autoimmunity on the bowel?

A

pernicious anaemia, inflammatory bowel disease

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11
Q

what is the effect of autoimmunity on the kidneys?

A

nephritis, glomerulonephritis

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12
Q

what is the effect of autoimmunity on the joints?

A

rheumatoid arthritis

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13
Q

what is the effect of autoimmunity on the skin?

A

vitiligo, pemphigus, psoriasis

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14
Q

what is the effect of autoimmunity on the eyes?

A

scleritis, karatitus, uveitis

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15
Q

what is the effect of autoimmunity on the nervous system?

A

MS

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16
Q

what is rheumatoid arthritis?

A

most common inflammatory arthritis, widespread joint pain, stiffness and swelling leading to joint destruction

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17
Q

how prevelant is RA?

A

0.8% of UK

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18
Q

who has a higher risk of developing RA?

A

females, 2-3x greater than males

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19
Q

what are the symptoms of RA?

A

joint pain
stiffness
joint swelling
fatigue
systemic
weight loss
fevers
extra articularfeatures

20
Q

what does RA affect?

A

synovial tissue, lining of joints
-can also affects extra articular manifestations

21
Q

what is the systemic autoimmunity phase before arthritis?

A

-onset is unclear
-autoantibodies
-increased cytokines and chemokine
-altered cholesterol metabolism

22
Q

what is rheumatoid factor (RF)?

A

antibody directed against Fc or IgG

23
Q

what is anti-CCP antibodies/ACPA?

A

CCP- cyclic citrullinated peptide
ACPA - anti citrullinated protein antibodies
citrulline replaces arginine (post translational modifications)

24
Q

why does joint inflammation start?

A

-unclear (maybe permeably or citrullinated. peptides)
-activated monocytes/macrophages, neutrophils, osteoclasts
-release cytokines and chemokine which lead to damage

25
Q

how is RA treated?

A

-NSAIDs
-corticosteroids
-DMARDs
conventional synthetic DMARDs (csDMARDs0
biologics (biological DMARDs/ bDMARDs0
small molecule inhibitors (tsDMARDs)
-combinations are better than single drug

26
Q

what are NSAIDs?

A

non steroidal anti-inflammatory drugs

27
Q

what are DMARDs?

A

disease modifying anti-rheumatic drugs

28
Q

what are some of the commonly used DMARDs for RA?

A

-methotrexate
-sulphasalazine
-leflunomide
-gold
-hydroxychloroquine
-cyclosporin
-azathioprine
-penicillamine
(non specific immune suppressing drugs)

29
Q

what are biological agents?

A

drugs such as monoclonal antibodies, receptors or peptides, which have been developed rationally by targeting processes important in disease pathogenesis eg cytokines, T cells and B cells

30
Q

how id TNF- a pivotal in RA?

A

-ability to block cytokine signalling via its receptor
-TNF seen as ‘conductor’ of pathology in RA

31
Q

what are the remaining uncertainties of biosimilars?

A

-longterm efficacy and safety
-immunogenecity
-interchangeability
-many are made by non traditional pharmaceutical companies eg Samsung

32
Q

what are some examples of biological agents?

A

infliximab
adalimumab

33
Q

what are some examples of DMARDs?

A

methotrexate
leflunomide
sulfasalazine

34
Q

what is an example of a corticosteroid?

A

prednisolone

35
Q

what would a radiograph of RA show?

A

joint space narrowing
cartilage loss
osteopenia

36
Q

what are subcutaneous rheumatoid nodules?

A

systemic symptom
fibroid necrosis of subcutaneous tissue

37
Q

which joints of the hands are generally spared by RA?

A

distal interphalangeal joints

38
Q

what would analysis of synovial fluid form a RA affected joint show?

A

high protein levels
>50% increased neutrophils

39
Q

what is rheumatoid factor?

A

an autoantibody found in 80% of RA cases

40
Q

what does the swan neck deformity affect?

A

proximal interphalangeal (PIP) joint hyperextension and the distal interphalangeal (DIP) joint flexion

41
Q

what is sulfasalazine?

A

combination of sulfapyridine and 5-aminosalicyclic acid used for RA treatment (csDMARD

42
Q

what is an antibody more specific to RA than rheumatoid factor?

A

anti-cyclic citrullinated peptide

43
Q

what is pannus?

A

synovial tissue proliferation which leads to cartilage destruction and joint ankylosis

44
Q

what kind of Ig is a classic lab finding in RA?

A

IgG

45
Q
A

Week 2 - Inflammation and Infection (5 decks)

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