Rheumatoid arthritis Flashcards
RA is a inflammatory autoimmune p______
polyarthritis
Does RA normally present symmetrically or asymmetrically?
Symmetrically
What are risk factors for RA?
Women
Aged 30-50
Smoking
What genes are associated with RA?
HLA DR4
HLA DRB1
In genetically susceptible individuals, an _______ trigger may activate the immune system, leading to an autoimmune response
environmental
RA is due to a mutation in type _ collagen
2
In RA there is increased conversion of a____ to c___ (amino acids) in type 2 collagen to make citrullinated peptides
arginine to citruline
The immune system recognises citrullinated proteins as foreign and triggers the production of antibodies including a___-___
anti-CCP
anti- cyclic citrullinated peptide
The immune complexes containing anti-CCP and citrullinated peptides contribute to c_____ i______ and damage within the synovium
chronic inflammation
Persistent inflammation contributes to j____ d____, e______, and characteristic d_____
joint damage, erosion, deformities
What contributes to further pro-inflammatory recruitment to synovium?
IFN-a
The synovial lining expands and tumour like mass called _____ grows past the joint margins
pannus
The pannus destroys s_______ bone and articular c____
subchondral bone
articular cartilage
What time of day are symptoms worst?
In morning, at least first half hour.
name some deformities that could be seen in the hand?
Boutonniere
Swan neck
Z-thumb
Ulnar deviation
What is a popliteal synovial sac bulge called?
Baker’s cyst
What joints in the hand are often affected in rheumatoid arthritis?
MCP
PIP
(not DIP)
True or false: the joints are not normally hot or inflamed in RA
False
What joints are commonly affected in RA?
Wrist
Hand
Feet
Can affect ankles, knee, hips, shoulder and cervical spine
What are some extra-articular complications of RA?
PE in lungs
Pulmonary fibrosis
Increased risk of ischaemic heart disease
Episcleritis
Dry eyes
Spinal cord compression
CKD
Rheumatoid skin nodules
Due to chronic systemic inflammation and elevated inflammatory mediators circulating
What is a rare complication of long-standing RA?
Felty syndrome
What is the characteristic triad of Felty syndrome?
Rheumatoid arthritis
Neutropenia (low neutrophils)
Splenomegaly
What does Felty Syndrome mean?
Increased risk of infection that could be life-threatening
How do you diagnose RA?
Bloods:
Increased ESR and CRP
Normocytic normochromic anaemia
(can cause micro/macrocytic anaemia from medications)
Serology:
Positive anti-CCP
Positive RF (rheumatoid factor)
X-ray
What does RF do?
Rheumatoid Factor causes immune system activation against the patient’s own Fc portion of IgG resulting in systemic inflammation
What are the changes on an X-ray seen due to RA?
LESS
Loss of joint space
Eroded bone
Soft tissue swelling
Soft bones (osteopenia)
What are the X-ray changes in osteoarthritis?
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What is used to monitor disease progression in RA?
ESR and CRP
How do you treat RA?
DMARD - methotrexate (gold standard)
NSAID for analgesia
If very painful: intraarticular steroid injection
Biologics (good but expensive)
First line = Infliximab with methotrexate
Second line = rituximab
What is prescribed alongside methotrexate?
Folic acid
When is methotrexate contraindicated?
Pregnant ladies due to being a folate inhibitor
What exactly does infliximab do?
TNF-a inhibitor
How does rituximab work?
B cell inhibitor (CD20 target)
Monoclonal antibody, targets CD20 proteins on surface of B cells.
Immunosuppression
What is used instead of methotrexate in pregnant ladies with RA?
Sulfasalazine
Hydroxychloroquine
NSAIDs
Corticosteroids
How often is methotrexate taken?
1 tablet once a week
Folic acid also taken, one tablet once a week on different day to methotrexate
Hydroxychloroquine is traditionally an a__-______ medication
anti-malarial
How does hydroxychloroquine suppress the immune system?
Interferes with toll-like receptors, disrupting antigen presentation.
Increases pH in lysosome of immune cells
