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ICM Infectious Disease > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Pattern of RA?

A

Symmetric

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2
Q

Etiology of RA?

A

Unknown, thought to be genetic

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3
Q

What is associated with increased incidence of rheumatoid and lupus

A

STAT4 haplotypes chromosome 2

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4
Q

What is associated with increased risk of CCP positive RA?

A

TRAF1-C5 on chromosome 9

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5
Q

What does TRAF1-C5 code for?

A

Intracellular protein that mediates signal transduction through TNF receptors 1 and 2

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6
Q

Primary orchestrator of the cell mediated immune response in rheumatoid arthritis?

A

CD4 helper T-cells

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7
Q

What do patients with RA express at much greater rate than patients w/o RA?

A

HLA DR4 haplotypes

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8
Q

TNF, IL-1, IL-6 cause what?

A

Erosion of bone and cartilage

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9
Q

IL-1 and TNF do what?

A

Stimulate adhesion molecules

Increase recruitment of polymorphonuclear cells into the joints

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10
Q

What do polymorphonuclear cells release that degrades cartilage?

A

Elastase and proteases

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11
Q

Function of rheumatoid factor?

A

Unknown

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12
Q

How is rheumatoid factor released?

A

Stimulated CD4 stimulates B cells to produce immunoglobulins including rheumatoid factor

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13
Q

Function of IL-4 and IL-10?

A

Down regulate the inflammatory response

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14
Q

What happens to the synovial membrane in early RA?

A

Membrane becomes thickened due to hyperplasia and hypertrophy of synovial lining cells

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15
Q

When RA is established what does synovial membrane become?

A

Inflammtory tissue (pannus)

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16
Q

What is Pannus made up of?

A

Type A (macrophage like), type B (fibroblast like), and plasma cells

17
Q

Constitutional features of RA?

A

Morning stiffness lasting for hours

Malaise, fatigue

18
Q

Men or women more likely to get RA?

A

Womean 3:1 ratio

19
Q

Peak onset of RA?

A

30-55

20
Q

How do the joints feel in RA?

A

Joints have a warm boggy feel (soft and squishy)

21
Q

What joint does RA never infect?

A

DIP

22
Q

What does infection of DIP joints indicate?

A

OA or psoriatic arthritis

23
Q

Does RA get to the lower back?

A

NO!

24
Q

Finding between cardiac and RA?

A

Fourfold increase in cardiovascular events in rheumatoid population

25
Q

Treatment problems for RA involving ocular?

A

Corticosteroids cause Glaucoma and cataracts

Hydroxychloroquin causes retinal pigment epithelial toxicity

26
Q

Increase of sedimentation rate says what?

A

More inflammation

27
Q

Rheumatoid factor only predictive n which patients?

A

Those with polyarthritis

28
Q

Rheumatoid factor test best used in conjunction with what to up specificity to 98%?

A

Cyclic citrullinated peptide anitbodies ( anti-CCP)

29
Q

Polymyalgia Rheumatica very responsive to what?

A

Corticosteroids

30
Q

How do NSAIDS work?

A

Inhibition of COX in production of prostaglandin

31
Q

How many forms of COX?

A

2

32
Q

COX1 does what?

A

Constitutive functions (maintaining mucosal linking stomach, platelet function)

33
Q

COX2 does what?

A

Mediation of pain and inflammation

34
Q

Function of corticosteroids?

A

Inhibits synthesis of almost all Cytokines
Affects chemotaxis resulting in less inflamatory cells at site
Affects synthesis of COX2
Decrease circulating T cells

35
Q

What does the DMARD Sulfasalazine do?

A

Inhibits production of various prostanoids
Results in reduction of circulating activated lymphocytes
Inhibition of B cell activation

36
Q

How does Gold therapy work?

A

Numerous functions but importance of them is unknown

37
Q

What does Gold therapy inhibit?

A

Acid phosphatase
Collagenase
Protein kinase C
Phospholipase C

38
Q

What inhibits synthesis of purine nucleotides?

A

Methotrexate and azathioprine

39
Q

What inhibits pyrimidine?

A

Leflunomide (Arava)

ICM Infectious Disease (19 decks)

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