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Musculoskeletal > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Which susceptibility genes are there for RA

A

HLA DR4

PTPN22

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2
Q

Which environmental factors can lead to RA

A

Smoking
Gut microbiome
Viruses e.g EBV

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3
Q

Describe citrullination

A 
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
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4
Q

What does the combination of susceptibility genes and environmental factors lead to

A

Epigenetic modification
E.g formation of immune complexes and RF
Altered citrullination of proteins
Breakdown of immune tolerance

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5
Q

Which cytokines do infiltrating T cells release

A

IFN gamma

IL-17

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6
Q

What is the effect of T cells releasing cytokines

A

Recruit macrophages
Releasing further cytokines
Leading to synovial inflammation

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7
Q

Which cytokines do infiltrating macrophages release

A

IL-6
IL-1
TNF alpha

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8
Q

Which B cell has a pathogenic role in RA

A

CD20 +

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9
Q

What is the role of B cells in RA

A

Produce autoantiboeis

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10
Q

What is pannus

A

Thick, swollen synovial membrane with granulation tissue

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11
Q

What does pannus do

A

Damages cartilage

Erodes bone

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12
Q

What is neoangiogenesis

A

Formation of new blood vessels

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13
Q

What is the purpose of neoangiogenesis in RA

A

Provude nutrients to hypertrophic synovium

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14
Q

What angiogenic factors are released in RA

A

IL-8

Ve GF

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15
Q

What mediates cartilage destruction

A

Proteases released by activated synovial cells

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16
Q

What is bone destruction mediated by

A

Osteoclasts

Which are activated by RANKL

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17
Q

What is RANKL produced by

A

ActivatedT cells

18
Q

What is RF

A

IgM antibody that targets the Fc domain of self IgG antibodies

19
Q

What is RA

A

Chronic autoimmune disease characterised by peripheral symmetrical arthritis and other systemic features

20
Q

What is used to classify RA

A

EULAR/ACR criteria

21
Q

What EULAR/ACR score gives a definite Dx

A

6 or more

22
Q

RF for RA

A 
Female 
4th 5th decade
HLA DR4 
PTPN22
Smoking
23
Q

Symptoms of RA

A 
Pain 
Morning stiffness >30 mins 
Poor function 
Decreased ROM 
Joint inflammation 
Extra-articular involvement
24
Q

Signs of RA

A 
Swelling 
Tenderness
Decreased ROM 
Redness
Heat
Typically symmetrical 
Typically peripheral (hands)
25
Q

X-ray signs of RA

A 
Periarticular osteoporosis 
Soft tissue swelling 
Bone erosion 
Decreased joint space 
Subluxation
26
Q

1st line Rx RA

A

NSAIDs

27
Q

2nd line Rx RA

A

DMARDs
Methotrexate
Sulfasalazine

28
Q

3rd line Rx RA

A

Biologicals
TNF alpha
IL-1 inhibitors
Anti-B cell therapy

29
Q

Which anti-B cell therapy can be used

A

CD20 e.g Rituximab

30
Q

4th line Rx for RA

A

Steroids

31
Q

Are steroids recommended as a single therapy

A

No

32
Q

SE of steroids

A 
Skin thinning 
Hyperglycaemia 
Hypertension 
Osteoporosis 
Increased risk of infection
33
Q

Ix for RA

A 
RF 
Anti-CCP 
CRP 
ESR 
X-ray 
USS
34
Q

Extra-articular manifestations Lungs

A

Interstitial fibrosis
Peluritis
RA nodules

35
Q

Cardiac features

A

Pericarditis
IHD
Pericardial effusion

36
Q

Eye manifestations

A

Scleritis
Episclerotiis
Keratoconjunctivitis
2ndry Sjogrens

37
Q

Kidney manifestations

A

Amyloidosis

38
Q

Other manifestations RA

A

Carpal tunnel
Splenomegaly (felty snydrome)
Myositis

39
Q

Which DAS indicates remission

A

<2.4

40
Q

Which DAS score indicates eligibility for biological therapy

A

> 5.1

41
Q

Who is methotrexate CI in

A

Pregnant women

Musculoskeletal (13 decks)

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