Rheumatoid Arthritis Flashcards
RA is an organ specific autoimmune condition. T/F?
False it is systemic
Which genes can predispose rheumatoid arthritis?
HLA-DR1
HLA-DR4
What environmental factor can predispose rheumatoid arthritis?
Smoking
What is citrullination?
The conversion of an arginine amino acid to a citrulline amino acid
Which molecules are commonly modified in rheumatoid arthritis so that they are no longer recognised as self-antigens?
IgG antibodies
Type II collagen
Vimentin
In rheumatoid arthritis which cytokines are released by T cells to recruit macrophages?
IL-17
Interferon gamma
Which cytokines are secreted by T cells in rheumatoid arthritis to cause synovial cell proliferation?
TNF alpha
IL-1
IL-6
What is the name of the thick, swollen synovial membrane if granulation tissue formed in rheumatoid arhtritis?
Pannus
What is the pannus, in rheumatoid arthritis, composed of?
Fibroblasts
Inflammatory cells
Myofibroblasts
How does the pannus damage cartilage and the underlying bone in rheumatoid arthritis?
Blocks normal route for nutrition
Effects of cytokines on chondrocytes
Activated synovial cells release proteases which break down articular cartilage
Inflammatory cytokines increase RANK expression on T cells to promote bone resorption
What is the target of rheumatoid factor?
The constant Fc domain of altered IgG antibodies
The complement system is activated by anti-CCP binding to their citrullinated protein targets. T/F?
True
In rheumatoid arthritis inflammatory cytokines escape through the blood supply the cause extra-articular problems. Which cytokines promote fever in the brain?
IL-1
IL-6
What is the possible effect of rheumatoid arthritis on blood vessels?
Forms atherosclerotic plaques
What are rheumatoid nodules?
Bundles of inflammatory cells surrounding an area of necrosis
What are the symptoms of rheumatoid arthritis?
Bilateral symmetric pain and swelling of the small joints
Morning stiffness lasting over an hour
General signs of inflammation - fever, malaise, low appetite and weakness
What are the three joint presentations of RA?
Swan neck deformity
Boutonniere deformity
Ulnar deviation
What blood tests would be done in RA to check for general signs of inflammation?
Erythrocyte sedimentation rate
C reactive protein levels
What are the x ray signs of rheumatoid arthritis?
Decrease bone density
Narrowing of the joint space
Soft tissue swelling
Bone erosions
List examples of disease modifying anti-rheumatic drugs?
Methotrexate
Leflunomide
Sulfasalazine
Hydrochloroquine
How do infliximab and adalimumab work to treat RA?
The bind to and neutralise TNF alpha
How does etanercept work to treat RA?
It acts as a decoy receptor for TNF alpha
How does abatacept work to treat RA?
Inhibits costimulation of autoantibody producing B cells by T cells
How does rituximab work to treat RA?
It inhibits B cells
What are the problems with biologics in treating RA?
Partial responses are common
Remission is not often achieved
Risks and costs of therapy is high
TMF blocking agents used to treat RA are useful because the also have the effects of…?
Reducing cardiovascular events and systemic inflammation
Improving endothelial function
Reducing vascular stiffness, fibrinogen, homocysteine and lipoproteins
Increasing lipid concentration
