Rheumatoid Arthritis 2b Flashcards
Which molecule is most sensitive for diagnosing RA? [1]
ACPAs - Anti-citrullinated peptide antibodies
Describe role of ACPAs in RA [3]
ACPAs bind directly into osteoclast
* Causes osteoclast to make IL-8
* IL-8 drives osteoclast and neutrophil recruitment (which causes NETosis)
ACPA can also bind to macrophages in SF and synovial membrane: produce pro-inflammatory cytokines and drive disease progression
90% of people that have no symptoms who are positive for ACPAs develop RA within [] years
3 years!
Describe the prognosis of RA if found to have PAD4 autoantibodies [2]
PAD4 autoantibodies are associated with more severe, erosive RA that persists despite treatment with TNF inhibitors
Describe what the process of carbamylation is [1]
What process causes this to occur more? [1]
Whic autoantibodies are associated with carbamylation [1]
Carbamylation converts lysine into homocitrullines by chemical reaction with cyanate
Smoking
Anti-carbamylated protein antibodies (anti-CarP antibodies): go to range of self-proteins and can bind to osteoclasts (and make IL-8 etc) but also cause further inflamation.
Which three molecules, if found, are a very good indicator have RA? [3]
Triple positivity (RF, ACPA and A-CarP) almost exclusive in RA not in other forms of early arthritis
Treatment of RA
What information is important (with regards to pathophysiology of RA) is key for treatment for patients? [1]
Diversity of AMPAs (anti-modified protein antibodies)
What is the anchor drug for RA? [1]
What is difference in dose for seropositive / seronegative? [1]
Methotexate
Seropositive: need higher dose to start and go on dose for longer
Which types of drugs are better for seropostive patients? [1]
Which types of drugs are better for seronegative patients? [1]
Seropositive RA patients:
* biologicals that target B-cells or inhibit T-cell co-stimulation are particularly effective (compared to TNF-a inhibitors)
seronegative RA patients
* Biologicals that target cytokines less difference
How quickly should methotrexate be started within RA symptom onset? [1]
3 months
Which molecule is required for NET formation and bacterial clearance? [1]
PAD4
Which drug targets autoantibodies in RA? [1]
Rituximab
IL-1, Il-6 and and TNF-a leak out into the blood stream in RA and cause systemic inflammation. State 4 diseases this can cause [4]
Anaemia
Thombocytosis
Osteoporosis
Fatigue
Muscle waisting
Name an extra-occular disease caused by RA [1]
Scleritis
State the type of anaemia initially seen in RA [1]
State the type of anaemia seen in progressive RA [1]
Initially:
* Normocytc, normochromic anaemia
Progession:
* Hypochromoic, normocytic anaemia
What are rheumatoid nodules [1]
Firm subcutaneous lumps that form in around 20% of RA patients
Usually form around joints that are subject to trauma (pressure)
Finger joints and elbows are common but also back of the heel
