Rheumatoid Arthritis

Question 0

ACPA pos vs neg

Answer 0

pos-worse effects

neg- never develop full RA

Question 1

why is ACPA better than RF

Answer 1

RF is seen in other autoab fisorders while ACPA is specfici to RA
it also shows that there will be systemic effectsq

Question 2

early RA and ACPA

Answer 2

50%

Question 3

established RA and ACPA

Answer 3

75%

Question 4

refractory RA and ACPA

Answer 4

85%

Question 5

HLAII interacts with

Answer 5

CD4+ cells

Question 6

5 amino acids on HLADR beta chain

Answer 6

increase risk of APCA because they can present cirtullinated proteins to CD4+–>make ACPA protein

Question 7

ACPA trajectory

Answer 7

begins to appear in serum–>no sx appear–>breach of tolerance occurs–>amplification–>joint targeting–>tissue injury

Question 8

ACPA and innate immunity

Answer 8

forms immune complexes–>fix complement/stimulate MO–>MO make TNFa and iL6

Question 9

patho of RA

Answer 9

inflammation of synovium increases cell proliferation
synovium turns to lymphoid tissue
joint destruction-pannus formation

Question 10

after joint destruction you can have one of..

Answer 10

remission
destruction of cartilage–fibrous, bony ankylosis
weakning,s carring rupture of periarticular structures to decrease fx

Question 11

Pannus

Answer 11

inflammatory granualtion tissue under the articular cartilage that is made of PMNs and macrophages, generating proteases and synovial fibroblasts that make collagenase and stomeylsin c–>degrading cartilage matrix

Question 12

where is the most common place for RA

Answer 12

hnads»>feet

Question 13

symmetry

Answer 13

polyarticular jt involvement in symmetrical distribution–RULE

Question 14

worse in what time of day

Answer 14

morning

Question 15

onset of RA

Answer 15

variable

Question 16

pain increases with

Answer 16

rest

Question 17

constitutinal sx

Answer 17

loss of strength in hands, fatigue, low grade fever, malaise

Question 18

what in areas are involved

Answer 18

wrist
elbow
shoulder
hands excpet DIP
**loss of symmetry- should question dx

Question 19

how to score dx

Answer 19

lateral MCP or MTP sequeeze is scored 1-3

wince when shake hands
inability to oppose distal pulp space (claw)

Question 20

specific PE findings

Answer 20

swelling of 2nd MCP
sublaxation–ulnar deviation because of how we right
swan neck-DIP flex, PIP extension
Boutonniere

Question 21

swwhy does swan neck happen

Answer 21

synovial erosion of nearby ligs

Question 22

why does boutonniere occur

Answer 22

bone erosion, forming nodules

if knee- baker’s cyst

Question 23

risk factor for OA vs RA

Answer 23

OA-wt loss

RA- smoking

Question 24

what do we check for OA vs RA

Answer 24

1st MCP for OA vs 2nd and 3rd for RA

Question 25

lab testing RA

Answer 25

anemia chronic disease increase SED and CRP synovial fluid- turbid, non-viscuous, demonstartes wbc >1000

Question 26

RF

Answer 26

IgM to Fc of IgG--seen in 70% of RA, but not specific because 5% of normal population has it in elderly increase in titer-worse Px

Question 27

argument for aggressive therapy

Answer 27

damage occurs early-worst in first year | any DMARD is better than placebo-MTX first line

Question 28

when shouldnt you use hydroxychloroquineee

Answer 28

eye disease

Question 29

BEST for RA

Answer 29

step up with combos of methrotrexate sulfasalazine mtx/infliximab

Question 30

hematological extra-articular signs

Answer 30

common-anemia | uncommon-felty's-leukopenia, splenomegaly, RA (+/- leg ulcers)

Question 31

dermatologic

Answer 31

rheumatoid nodules-occur following trauma that ruptures vessels at point of impact releasing RF and IC very uncommon-digital infarcts, livedo reticularis

Question 32

neurological

Answer 32

common-entrapment neuropathy uncommon-antlantoaxial subluxation-paraplegic due to spinal cord compression following a surgery because neck was flexed while intubated very uncommon-peripheral neuropathy

Question 33

5 forms of pulmonary issues associated with increase RF/ACPA

Answer 33

``` pulmonary fibrosis nodules pneummoconiosis bronchiolitis obliterans pleural effusion ```

Question 34

cardiac

Answer 34

high freq of pericardial effusion, manifesting as pericarditis instead of tamponade

Question 35

opthalmologic

Answer 35

sicca when RA assocaited with sjorgen syndrome- dysfunction of lacrimal glands because of lymphocyte infiltration

Question 36

vascular

Answer 36

very uncommon-->secondary to RF

Question 37

ACPA

Answer 37

specificity