Rheumatoid arthritis Flashcards
what cell types are found within the synovium?
macrophages and fibroblasts
what type of tissue is the synovial membrane?
loose connective tissue
what is RA synovitis characterised by?
inflammatory cell infiltration
neoangiogenesis
synoviocyte proliferation
particularly during acute flares of RA, what cell type is present within the synovoial fluid?
neutrophils
what antibodies are commonly associated with RA?
rheumatic factors
anti-citrullinated protein
what is the difference between sero positive and seronegative RA?
seropositive RA will show positive RF and anti-cirrulated protein antibody (ACPA)
they are more likely to have a more severe form of RA and show a poorer prognosis
how is seropositive RA diagnosed?
anti - CCP assay
if one twin has RA, what is the likelihood the other twin will have it? (monozygotic twins)
15-30%
5% if dizygotic twins
what environmental factors make you more susceptible to RA?
smoking and bronchial stress infections; - EBV, CMV - E.coli - mycoplasm - periodontal disease - microbiome (gut microbes)
what is rheumatoid factor and what does rheumatoid factor target?
auto-antibody that has a high affinity against the Fc portion of Ig (IgG and IgM)
= autoimmunity
describe the development of RA.
environmental factors + susceptibility genes + epigenetic modification
= self protein cirullation
= dendritic cells, T and B cells, autoantibodies ACPA production
= inflammation
= transition to arthritis
what primarily mediates bone destruction in RA?
osteoclasts and fibroblast like synoviocytes
what are the systemic consequences of RA?
vasculitis, nodules, scleritis, amyloidosis CV disease anaemia interstitial lung disease, fibrosis sarcopoenia osteoporosis secondary sjogren's syndrome
what are the orthopaedic complications of RA?
chronic synovitis mechanical deformities secondary osteoarthritis poor function pain
what clinical signs can you find in the hands of someone with rheumatoid arthritis?
Z shaped deformity of the thumb
ulnar deviation of the phalanges at the knuckles (MCP)
swan appearance - hyperextension of PIP with flexed DIP
boutonnières - hyperextension of DIP with flexed PIP
what are the x-ray changes of rheumatoid arthritis?
Joint destruction and deformity
Soft tissue swelling
Periarticular osteopenia
Boney erosions
what factors indicate a more severe form of rheumatoid arthritis?
male younger onset more joints and organs affected presence of RH and/or anti-CCP erosions seen on x-ray
how is rheumatoid arthritis diagnosed?
examination of joints affected (smaller and more joints have higher score)
serology (anti-CCP and RF)
inflammatory markers (CRP/ESR)
duration of symptoms (more or less than 6 weeks)
what is the management algorithm of rheumatoid arthritis?
intra-articular steroid injections for flare ups
- NSAIDs and COX3 inhibitors can also be used
1st line: DMOARDS
- methotrexate, sulfazalazine, leflunomide or hydrocholoquine
2nd line:
- combine 2 of those
3rd line:
- methotrexate + biologics
4th line:
- methotrexate + rituximab
how do you manage acute flare ups of rheumatoid arthritis?
intra articular steroid injections
or NSAIDS and COX3 inhibitors
what is used to assess rheumatoid arthritis severity?
DAS82
disease activity score 28 (how many joints out of 28 are affected)
what genes are involved in the development of rheumatoid arthritis?
HLA II and PTPN22
what treatment can be given to a pregnant women for her rheumatoid arthritis?
anti-TNF alpha therapist i.e. Sulfasalazine
