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Course 2 - Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

what is rheumatoid arthritis?

A

Systemic autoimmune disease characterized by joint inflammation

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2
Q

epidemiology of RA

A

most common systemic/inflammatory rheumatic disease
1% of adults
HLA-DR4 alleles for risk of disease
F>M

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3
Q

define autoimmune diseases

A

own immune system stimulated to act against self, produce Ab to self antigens

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4
Q

what is arthralgia

A

joint pain

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5
Q

where does the inflammation occur

A

synovium

pain due to nerve endings on subchondral bone

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6
Q

what are causes of RA

A

idiopathic

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7
Q

role of synoviocytes in RA

A

synovial hyperplasia

produce proinflammatory cytokines

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8
Q

role of macrophages in RA

A

APC
synoviocyte and tissue type macrophage
ingest and process antigens
present to HLA-DR matched T cells

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9
Q

role of dendritic cells in RA

A

APC, activate naive T cells
self-antigen presentation to T cells
inappropriate DC activation could convert self-tolerance to overt autoimmunity

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10
Q

role of T cells in RA

A 
interact w APC through MHCI (HLA-A,B,C)) and MHCII (HLA-DR, DP, DQ)
produce cytokines (interleukins, IFN gamma, TNF-alpha and beta)
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11
Q

3 critical roles of B cells in RA

A

antigen presentation and T cell activation
autoantibody production
cytokine production

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12
Q

role of fibroblasts in RA

A

produce hyaluronan

inflammation - produce metalloproteinases

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13
Q

role of complements in RA

A

immune complex activate cascade (rheumatoid factor is component of complex)
complement fragments attract neutrophils
degranulation –> enzymes damage cartilage

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14
Q

what are suspected pathogenic antigens

A

virus (CMB, herpes, EBV, rubella)
bacteria (staph, strep, borelia)
mycoplasma

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15
Q

what are suspected auto-antigens

A

type 2 collagen, proteoglycan, chondrocyte, IgG

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16
Q

describe TNF alpha action on macrophages

A

increase pro-inflammatory cytokines and chemokines, increases inflammation

17
Q

describe TNF alpha action on endothelium

A

increase adhesion molecules (increased cell infiltration) and vascular endothelial growth factor (VEGF) (increased angiogenesis)

18
Q

describe TNF alpha action on hepatocytes

A

increased acute phase response –> increased CRP in serum

19
Q

describe TNF alpha action on synoviocytes

A

increased metalloproteinase synthesis –> articular cartilage degradation

20
Q

how does IL-6 cause anemia of chronic inflammation

A

inducing hepcidin production by hepatocytes

hepcidin inhibits release of iron from macrophages

21
Q

what genetic factors are associated with RA

A

HLA-DRB1 (increased risk)
HLA-DR4 (severe disease)
STAT4
infectious agents, smoking, and sex hormones

22
Q

what is seen on XR for RA

A

early erosion, soft tissue swelling

23
Q

5 steps in pathophysiology in RA

A
  1. antigen presentation to B & T cells
  2. T and B cells proliferate, cytokines released, angiogenesis occurs
  3. synovial hypertrophy with cell accumulation in joint space
  4. joint space invasion, enzymatic damage
  5. bone erosion, loss of cartilage
24
Q

what causes systemic complaints in RA

A

effects of inflammatory mediators

fevers and poor appetite

25
Q

what are extra-articular features of RA

A

nodules
vascular/resp system
cardiovascular
neurological

26
Q

where do RA nodules occur?

A

where there is pressure (achilles tendon, pulp of digits)
extensor surfaces, peri-articular
on tendons

27
Q

what are respiratory features of RA

A 
pleural disease (chest pain, dyspnoea)
interstitial lung disease
28
Q

what are cardiovascular features of RA

A 
pericardial disease (chest pain, dyspnoea)
cardiac muscle disease (due to nodules)
29
Q

what are vascular features of RA

A

small vessel disease

symptoms dependent on site of vasculitis (skin, bowel, nerve, eye)

30
Q

what are neurological features of RA

A

peripheral nerves may be affected
median nerve (carpal tunnel, pain and/or paraesthesiae in palm or in 1st to 4th digits)
worse with activity or at night

31
Q

describe Sjogren’s syndrome

A

immune system disorder that accompanies RA
dry eyes (eyelids sticking together)
dry mouth
other organ dryness

32
Q

describe Felty’s syndrome

A

seropositive chronic RA
splenomegaly
granulocytopenia

causes joint damage, leg ulcers, recurrent infections

33
Q

factors associated with poor prognosis in RA

A 
load of disease (# of swollen and tender joints) 
presence of rheumatoid factor 
anti-CCP antibodies 
HLA-DR4 haplotype 
presence of erosions on XR

Course 2 - Rheumatology (8 decks)

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