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Block 4 > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What part of a joint is affected in a degenerative joint disorder e.g. osteoarthritis?

A

Hyaline cartilage (degeneration, wearing with age)

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2
Q

What part of a joint is affected in an inflammatory joint disorder e.g. RA?

A

Synovium of the joint

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3
Q

What condition is characterised by a build up of crystal in the joints i.e. crystal arthropathy?

A

Gout

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4
Q

Which bacteria commonly causes septic arthritis?

A

Streptococcal

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5
Q

Name 3 viral infections that can cause inflammatory arthritis

A

Hep B

Hep C

Rubella (German measles)

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6
Q

Which cells in a joint capsule secrete synovial fluid?

Where can they be found?

A

Synovocytes

Synovium (serous membrane)

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7
Q

Give 2 purposes of synovial fluid

A

Metabolite exchange medium

Lubricant for synovial joints

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8
Q

Where are T cells made?

A

Cortex of the thymus gland

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9
Q

What virus causes glandular fever?

A

Epstein-Barr virus (EBV)

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10
Q

Which HLA gene is connected with RA?

A

HLA-DR4

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11
Q

Which autoimmune diseases are associated with HLA-DQ2?

A

T1DM

Coeliac disease

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12
Q

What are rheumatoid factors?

A

IgM autoantibodies directed against the Fc fragment of immunoglobulin G (IgG).

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13
Q

Which autoantibody are rheumatoid factors made from?

A

IgM

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14
Q

Which autoantibody to rheumatoid factors fight against?

A

IgG

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15
Q

Why is rheumatoid factor not good at diagnosing joint pain?

A

10-25% false positives in over 70s

If patient comes in with joint pain, RF will not diagnose RA.

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16
Q

What are some common clinical features in RA?

A

Young-middle aged females (20-50)

Pain and stiffness in joints

Gradual or sudden onset

Usually symmetrical, hands, feet, other joints

Often FH

Smoking increases the risk

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17
Q

When is stiffness most profound in RA?

A

In the mornings when they’re ‘trying to get going’

18
Q

What are the 3 S’s for inflammatory arthritis?

A

Stiffness - early morning for more than 30 mins

Swelling - usually hand joints

Squeezing - painful to squeeze joint

19
Q

Which joints are most commonly affected in RA?

A

Metacarpal/metatarsal-phalangeal joints of hands and feet

20
Q

What features can be seen in the hand in RA?

List them in order of disease progression

A

Ulnar deviation of fingers + metacarpal-phalangeal subluxation

Swan neck deformities

Boutonniere deformities

21
Q

Why can RA cause nerve compression?

A

C1/C2 atlantoaxial subluxation - involvement of these vertebrae can put pressure on the spinal cord

22
Q

What is the classic positional presentation of pericarditis?

A

Sitting forward eases pain

Lying back decreases pain

Pericarditis can be a complication of RA and present as ACS with potentially no ECG changes

23
Q

Which cytokine produced by the T-cell mediated immune response destroys articular cartilage and bone?

A

IL-1

24
Q

In late disease, the synovium can get inflamed and proliferate. When this starts to invade surrounding tissues, what is the structure called?

A

Pannus

Very vascular structure, invades bones and cartilage

25
Q

What blood results would you expect in RA?

A

Anaemia (normocytic normochromic), anaemia of chronic diseases

ESR/cRP: moderately raised

Immunology: Anti-CCP - +ve in 60% RA patients

ALP - raised

Albumin - decreased

26
Q

If ALP is raised alongside bilirubin, GGT or ALT, what does this suggest?

A

That the raised ALP is coming from the liver, showing liver damage

27
Q

If ALP is raised alongside calcium and phosphate, what does this suggest?

A

That the raised ALP is coming from the bone

28
Q

What would an iron deficiency anaemia look like on a blood test?

A

Microcytic (low MCV)

29
Q

What would a B12 deficiency aneamia look like on a blood test?

A

Macrocytic

30
Q

Which 2 substances can effect the ESR?

A

Fibrinogen (levels increase in inflammation)

Immunoglobulins

31
Q

What changes could be seen in an Xray of someone with RA?

A

Soft tissue swelling

Joint space narrowing

Erosions

Subluxation

Deformity

Juxta-articular osteopenia (reduced bone density next to the swelling)

32
Q

What 2 drugs are given in combination treatment of RA?

A

Sulphasalazine

Methotrexate

33
Q

What is the MoA of sulphasalazine?

What other drug is in this family?

A

Aminosalicylates

Anti-inflammatory, ?COX inhibition

Mesalazine

34
Q

What is the MoA of methotrexate?

What other drug is in this family?

A

Inhibits the enzyme dihydrofolate reductas which inhibits DNA synthesis. This reduces lymphocyte proliferation

Azothiprine

35
Q

What corticosteroid can be used short term to treat arthritis?

A

Prednisolone

36
Q

Why are corticosteroids (prednisolone) useful in RA?

Think MoA

A

General immunosurpressors

Reduced transcription of cytokines e.g. IL-1 and IL-2

This reduces the proliferation of T helper cells (involved in autoimmunity)

37
Q

How often is methotrexate given?

A

Once weekly

38
Q

Name some side effects of methotrexate

A

Teratogenic (attacks any rapidly dividing cells)

Tiredness (signs of anaemia)

GI side effects - mouth ulcers, diarrhoea

Hair loss

Increased risk of infections

39
Q

Name 2 monoclonal antibodies used in the treatment of RA

A

Infliximab

Rituximab

40
Q

What is the MoA of infliximab?

A

Binds and blocks proinflammatory function of TNF-alpha

Anti-TNFa

41
Q

What is the MoA of rituximab?

A

Anti-CD20 on B cells

42
Q

How are infliximab and rituximab administered?

A

IV infusion

Block 4 (11 decks)

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