Rheumatoid Arthritis Flashcards
Which susceptibility genes are there for RA
HLA DR4
PTPN22
Which environmental factors can lead to RA
Smoking
Gut microbiome
Viruses e.g EBV
Describe citrullination
When argenine is converted to citrulline Loss of immune tolerance So gets picked up by APC And recognised as foreign Ab made by B cells against it So self antibodies are made
What does the combination of susceptibility genes and environmental factors lead to
Epigenetic modification
E.g formation of immune complexes and RF
Altered citrullination of proteins
Breakdown of immune tolerance
Which cytokines do infiltrating T cells release
IFN gamma
IL-17
What is the effect of T cells releasing cytokines
Recruit macrophages
Releasing further cytokines
Leading to synovial inflammation
Which cytokines do infiltrating macrophages release
IL-6
IL-1
TNF alpha
Which B cell has a pathogenic role in RA
CD20 +
What is the role of B cells in RA
Produce autoantiboeis
What is pannus
Thick, swollen synovial membrane with granulation tissue
What does pannus do
Damages cartilage
Erodes bone
What is neoangiogenesis
Formation of new blood vessels
What is the purpose of neoangiogenesis in RA
Provude nutrients to hypertrophic synovium
What angiogenic factors are released in RA
IL-8
Ve GF
What mediates cartilage destruction
Proteases released by activated synovial cells
What is bone destruction mediated by
Osteoclasts
Which are activated by RANKL
What is RANKL produced by
ActivatedT cells
What is RF
IgM antibody that targets the Fc domain of self IgG antibodies
What is RA
Chronic autoimmune disease characterised by peripheral symmetrical arthritis and other systemic features
What is used to classify RA
EULAR/ACR criteria
What EULAR/ACR score gives a definite Dx
6 or more
RF for RA
Female 4th 5th decade HLA DR4 PTPN22 Smoking
Symptoms of RA
Pain Morning stiffness >30 mins Poor function Decreased ROM Joint inflammation Extra-articular involvement
Signs of RA
Swelling Tenderness Decreased ROM Redness Heat Typically symmetrical Typically peripheral (hands)
X-ray signs of RA
Periarticular osteoporosis Soft tissue swelling Bone erosion Decreased joint space Subluxation
1st line Rx RA
NSAIDs
2nd line Rx RA
DMARDs
Methotrexate
Sulfasalazine
3rd line Rx RA
Biologicals
TNF alpha
IL-1 inhibitors
Anti-B cell therapy
Which anti-B cell therapy can be used
CD20 e.g Rituximab
4th line Rx for RA
Steroids
Are steroids recommended as a single therapy
No
SE of steroids
Skin thinning Hyperglycaemia Hypertension Osteoporosis Increased risk of infection
Ix for RA
RF Anti-CCP CRP ESR X-ray USS
Extra-articular manifestations Lungs
Interstitial fibrosis
Peluritis
RA nodules
Cardiac features
Pericarditis
IHD
Pericardial effusion
Eye manifestations
Scleritis
Episclerotiis
Keratoconjunctivitis
2ndry Sjogrens
Kidney manifestations
Amyloidosis
Other manifestations RA
Carpal tunnel
Splenomegaly (felty snydrome)
Myositis
Which DAS indicates remission
<2.4
Which DAS score indicates eligibility for biological therapy
> 5.1
Who is methotrexate CI in
Pregnant women
