Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LCRS Musculoskeletal > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Chronic autoimmune disease characterised by pain, stiffness and symmetrical synovitis (inflammation of synovial membrane) of synovial joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a key identifying feature of arthritis?

A

It is symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do patients with rheumatoid arthritis tend to present?

A

Pain and swelling in both hands/wrists/knees- stiffness in and around joints which is particularly bad in the morning is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does the stiffness in rheumatoid arthritis change with exercise?

A

It gets better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do you need to that and modify the natural history of the disease?

A

The inflammation damages the joints (joint erosions on radiographs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does extra-articular disease that can occur with rheumatoid arthritis consist of?

A

Rheumatoid nodules

Others are rare e.g. vasculitis, episcleritis- Rheumatoid factor forms immune complexes which can go anywhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where can rheumatoid factor be detected?

A

In the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is rheumatoid factor sometimes called rheumatoid antibody?

A

It is an IgM autoantibody against |gG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the gender distribution of rheumatoid arthritis like?

A

More common in females- 3 times more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common cause of cause?

A

Chronic synovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What genetic component is very strongly linked to rheumatoid arthritis (shared epitope)?

A

A specific set of amino acids within the beta chain of the DR molecule which is conceived among all HLA subtypes associated with rheumatoid arthritis- referred to as the shared epitope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What lifestyle factor increases susceptibility and severity of the disease?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What joints are most commonly affected in rheumatoid arthritis?

A 
Metacarpophalangeal  joint
Proximal interphalangeal joint
Wrists
Knees
Ankles
Metatarsophalangeal joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the swan neck deformity?

A

Hyperextension at PIP

Hyperflexion at FIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is boutonniere deformity?

A

Hyperflexion at PIP

Synovitis has damaged joints and the tendons are pulling an abnormal joint which causes “button deformity”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is dactylitis?

A

Whole digit is swollen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a patient presented with several fully swollen fingers how do you know this isn’t rheumatoid?

A

Not just the joints that are swollen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does tenosynovium do?

A

Wraps around tendons to allow them to move freely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are bursas?

A

Pockets of fluid that are found on the surface of the joints- can get inflamed causing bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are subcutaneous nodules?

A

Rheumatoid factor produces immune complexes that can deposit in any tissue and they have a tendency to deposit in subcutaneous tissue and cause extra-articular manifestations

21
Q

Where are rheumatoid nodules commonly seen?

A

Along ulnar border of forearm

22
Q

What is rheumatoid factor?

A

IgM antibody that recognises and binds to Fc portion of |gG as their target antigen

23
Q

Why isn’t Fc portion of IgG used as diagnostic test?

A

1/3 of rheumatoid arthritis is rheumatoid factor negative

24
Q

Antibodies against what are highly specific for rheumatoid arthritis?

A

Citrullinated peptides

25
Q

What is citrullination of peptides mediated by?

A

Enzymes called peptidyl arginine deaminase (PADs)

26
Q

Why do citrullinated peptide antigens develop in rheumatoid arthritis?

A

PADs are present in high concentrations in neutrophils and monocytes and consequently there is increased citrullination of autologous peptides in inflamed synovium

27
Q

What extra-articular features are common in rheumatoid arthritis?

A

Fever
Weight loss
Subcutaneous nodules
(Others are vasculitis, ocular inflammation, neuropathies, amyloidosis and lung disease)

28
Q

What are the three common extra-articular features caused by?

A

Abnormal cytokine response

29
Q

In the early stages, what radiographic abnormalities are there?

A

Juxta-articular osteopenia (less dense around joints)

30
Q

In later stages, what radiographic abnormalities are there?

A

Joint erosions at margins of joint

Joint deformity and destruction

31
Q

What happens to synovial membrane in rheumatoid arthritis?

A

It becomes thickened and chronically inflamed and will cause joint swelling

32
Q

What is pannus?

A

Synovial tissue that is chronically inflamed

33
Q

What happens after synovial tissue is inflamed?

A

It starts to eat away at adjacent bone starting with small area of bone which isn’t covered by articular cartilage- periarticular erosions are seen first

34
Q

What is the cellular structure of synovium like?

A

It is almost a single cell lining and there are macrophages and fibroblasts (which produce synovial fluid) within synovial lining

35
Q

Why is synovial fluid viscous?

A

It contains a lot of hyaluronic acid

36
Q

What is articular cartilage made up of?

A

Type 2 collagen- main proteoglycan is aggrecan

37
Q

Why does the synovium become a proliferated mass of tissue (panes)?

A

Neovascularisation- formation of new blood vessels

Lymphangiogenesis- formation of new lymphatics

38
Q

What cells will there be a lot of within the joint?

A 
Inflammatory:
Activated B and T cells
Plasma cells
Mast cells
Activated macrophages
39
Q

How is there a cytokine imbalance?

A

Excess of pro-inflammatory cytokines

40
Q

What are the key cytokines involved?

A

IL-1
IL-6
TNF-alpha

41
Q

What does pleiotropic mean?

A

When one gene influences two or more seemingly unrelated phenotypic traits. Consequently a mutation in a pleiotropic gene may have an effect on some or all traits simultaneously

42
Q

What is the aim of treatment for rheumatoid arthritis?

A

Prevent joint damage

43
Q

What are DMARDS?

A

Disease-modifying anti-rheumatic drugs

Dont cure but may induce remission and prevent joint damage- reduces inflammation in synovium

44
Q

What examples of DMARDs are there?

A 
Methotrexate (commonly used)
Sulphasalazine (commonly used)
Hydroxychloroquine (commonly used)
Leflunomide (uncommon)
Gold (rarely used now)
45
Q

What is the problem with DMARDs?

A

All have significant adverse effects so require regular blood test monitoring during therapy

46
Q

What is the problem with biological therapy?

A

Drugs are very expensive

Increased infection

47
Q

What is TNF alpha inhibition associated with?

A

TNF alpha inhibition is associated with increased susceptibility to mycobacterial infection (in, particular, tuberculosis)- all patents need to be screened for TB

48
Q

What is B cell depletion therapy associated with?

A

Hepatitis B reactivation so need to screen all patients for hep B before treatment
Also associated with JC virus infection and progressive multifocal leukoencephalopathy

LCRS Musculoskeletal (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions