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
Explain the pathophysiology of anaemia with RA [4]
- Dysregulation of iron homeostasis
- Decreased iron availability for RBC production
- Blunted EPO response
- Impaired proliferation of erythroid progenitor cells
- Shortened lifespan of RBC
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
Which of these joints would you least likely see swollen & painful joints in RA?
