Rheumatoid Arthritis Flashcards
True of false: there is an increased mortality rates in patients with RA.
TRUE- increased 2 times over general populations (probably due to lymphomas and CV disease)
What is the HLA association with RA?
HLA-DRB1
What does HLA-DRB1 (4) do?
DR-4 is on antigenic presenting cell and selectively binds things like arthritogenic peptides and presents antigen to T cells
What is PTPN22?
protein tyrosine phosphatase N22 gets a missense mutation and it messes up the encoded gene that usually inhibits T cell activation
Is RF always associated with rheumatoid arthritis?
NO- patients with active Hep C, Sjogren’s syndrome, MCTD, etc. can have a positive RF
Does RF establish the diagnosis of RA?
NO
What is rheumatoid factor?
IgM autoantibodies that bind to Fc receptors of IgG in own body
What are anti-CCP antibodies?
cyclic citrullinated peptide (more specific for RA than RF)
What factor is seen in 20% of RA patients?
ANA (NOT ALWAYS ASSOCIATED WITH LUPUS)
What are some systemic features of RA? When do they occur?
Prodrome to disease onset (fatigue, anorexia, weight loss, weakness, generalized aching/stiffness)
How fast does RA come on?
often insidious, occurs over weeks to months
there is explosive onset and there is intermittent onset
Is RA usually migratory?
NO
What are the initial sites of RA in joints?
hip and knee
What produces anti-CCPs?
synovial tissue B cells (can be detected in synovial fluid)
True or false: anti-CCPs can be present before the development of RA.
TRUE! is predictive of progression to RA in patients iwth early undifferentiated inflammatory arthritis
What do autoantibodies in RA target?
joint antigens (type II collagen) or systemic antigens (glucose phosphate isomerase)
What are the parameters used to diagnose RA?
joint distribution
serology
symptom duration
acute phase reactants
What are the characteristics of RA synovial fluid?
Leukocyte count 2,000-75,000/mm^3 with > 50% PMNs
may also see autoantibodies, PGs, and leukotrienes
What T cell cytokines are present in RA?
INF-gamma (from Th1) and IL-17 (from Th17)
What is the T regulatory cell function like in RA?
T reg cells are NOT functioning well in the synovial fluid
What is the typical pattern of joint involvement in progressive RA?
symmetrical involvement (shoulders, elbows, hips, knees, wrists, MCPs/PIPs)
When do RA patients get cervical spine involvement?
RARE: usually after years of poorly managed disease (may mainfest as neck pain only but carries risk of spinal cord compression)
What is a characteristic hand-finding in progressed RA?
ulnar deviation, swan neck deformities (hyperextension of PIP and flexion of DIP)
Can a patient have RA and osteoarthritis at the same time?
YES
Do you see erosions in osteoarthritis?
NO (characteristic of RA)
Where do rheumatoid nodules occur?
- olecranon process and proximal ulna (extensor surfaces)
- Pleura
- Meninges
- Ears
- Lungs
What is the skin manifestations of vasculitis in RA?
palpable purpura and leg ulcers
What causes dry mouth/dry eyes in RA?
lymphocytic infiltration into glands to diminish saliva/tear production
What are respiratory complications in RA?
- interstitial fibrosis
- pulmonary nodules
- pleuritis with pleural effusion
What are cardiac complications in RA?
- pericarditis (common but largely asymptomatic)
- nodule formation on valves
