Rheumatoid arthritis 2

Question 1

Does having the ACPA antibody guarantee getting RA?

Answer 1

No

Question 2

ACPA antibody and RA severity?

Answer 2

ACPA can predict erosive and progressive, more severe, disease

Question 3

Are rheumatoid factor and ACPA the only RA antibodies?

Answer 3

no, but they are the most commonly used for diagnosis

Question 4

Healthy joint structure?

Answer 4

Both bones are coated in cartilage
Synovial fluid is present (secreted by synovial membrane)
Encased by a joint capsule

Question 5

Role of cartilage in joints?

Answer 5

Allows joints to glide over one another

Question 6

Role of synovial fluid in joints?

Answer 6

To lubricate

Question 7

Where is the inflammation in RA?

Answer 7

Synovial membrane

Question 8

Which cytokines cause synovial membrane inflammaiton?

Answer 8

TNFalpha, IL6, IL1

Question 9

What causes RA swelling?

Answer 9

Thickening of synovial membrane, and extra fluid being secreted

Question 10

What happens if initial RA swelling is “left unchecked”?

Answer 10

Loss of cartilage, restricted movement and damage that is irreversible

Question 11

What happens to the synovial pathology in RA over time?

Answer 11

Lymphoid infiltrates initially, leading to pannus

Question 12

What is pannus in RA?

Answer 12

Fibrin deposition in and around the cartilage damage

Question 13

Is RA symmetrical?

Answer 13

Yes

Question 14

Which larger joints are affected to a lesser extent by RA?

Answer 14

Hips and knees

Question 15

Which symptoms are described more than pain by RA patients?

Answer 15

Stiffness, fatigue, malaise

Question 16

Which joints are always affected in RA?

Answer 16

Feet and hands

Question 17

What are swan neck changes?

Answer 17

Hyperextension and flexion of different finger joints, leading to an S shape forming

Question 18

Ulnar deviation?

Answer 18

Bending of the fingers towards the little finger

Question 19

What is a rheumatoid nodule?

Answer 19

Immune deposit on the elbow associated with rheumatoid factor presence

Question 20

Indication of RA on the skin?

Answer 20

Vasculitis–> blood vessel inflammation

Question 21

Indication of RA in the eyes?

Answer 21

Scleritis, episcleritis

Question 22

What do scleritis and episcleritis affect?

Answer 22

The eye–> white part

Question 23

Indication of RA on the lungs?

Answer 23

Fibrotic changes–> coughs and breathlessness
Nodules in the lungs

Question 24

How is disease activity in RA assessed?

Answer 24

FUnctional questionnaires, blood tests, ask patient how they feel

Question 25

Use of X-rays in RA assessment?

Answer 25

Understanding how progressive or destructive an arthritis is

Question 26

Radiological evidence of early RA?

Answer 26

Soft tissue swelling, narrowing of joint space, loss of cartilage

Question 27

Difference of bone edges between RA and healthy?

Answer 27

RA joint bones are eroded, healthy are smooth

Question 28

Pros and cons of MRI?

Answer 28

Can see more, but is expensive, slow

Question 29

Two tests good at looking at active inflammation?

Answer 29

Ultrasound and MRI

Question 30

Why are ultrasound and MRI tests good at looking at active inflammation?

Answer 30

They look at the soft tissues

Question 31

What are doppler images used to look at?

Answer 31

The flow of fluid--> i.e. blood through the synovium

Question 32

Methods of evaluation of RA?

Answer 32

Radiography, physical examination, laboratory, subjective

Question 33

What can indicate high levels of IL6?

Answer 33

An increase in C-reactive protein

Question 34

Targets of most potent drugs used in RA?

Answer 34

Cytokines--> anti TNF,

Question 35

How is TNF targeted?

Answer 35

Block receptors, remove it itself

Question 36

Why are B cells targeted to prevent an inflammatory response?

Answer 36

Stops the downstream activation of t cells

Question 37

What is DAS28?

Answer 37

DAS28 provides a number on a scale from 0 to 10 which indicates the current activity of the disease

Question 38

DAS28 of over 5.1?

Answer 38

High disease activity

Question 39

DAS28 of less than 3.2?

Answer 39

Low disease activity

Question 40

DAS28 of less than 2.6?

Answer 40

Remission

Question 41

HAQDI scoring?

Answer 41

Patients report how much difficulty they are having in performing various activities and these are scored as follows:

Question 42

HAQDI numbers meaning?

Answer 42

0-3 W/o any difficulty, w/ some, w/ much, unable to do

Question 43

Prognosis of RA?

Answer 43

Treatment is tailored depending on severity, and for most it is mild

Question 44

RA comorbidities?

Answer 44

Circulatory, respiratory, digestive, genito-urinary, malignant neoplasm

Question 45

Indicators of poor RA outcomes?

Answer 45

HLA-DRB1 gene, high ESR or CRP level at outset, +ve RF and ACPA, mant active joints, poor functional scores