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CAM102 Pathology > Rheumatoid arthritis and seronegative arthritis > Flashcards

Rheumatoid arthritis and seronegative arthritis Flashcards

1
Q

Is rheumatoid arthritis local or systemic?

A

Rheumatoid arthritis is a multi–systemic disorder involving various tissues and organs. It does however, affect mainly the joints.

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2
Q

What is rheumatoid arthritis characterised by?

A

Non-suppurative synovitis.

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3
Q

Is rheumatoid arthritis more common in men or women?

A

3-5 times more common in women than in men.

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4
Q

What age does rheumatoid arthritis occur at?

A

Occurs at any age but most common 40-70 years, however, incidence can occurs int eh twenties and forties.

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5
Q

What is the aetiogenesis of rheumtoid arthritis

A

Causes are still unknown. Recent studies suggest that intestinal microbiota may participate in the aetiopathogenesis of RA. Oral and intestinal bacterial DNAs have been found in serum and synovial fluid of patients.Affects susceptive subjects to unknown arthritogenic antigen.

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6
Q

What type of disease is rheumatoid arthritis?

A

It is an autoimmune disease. Causes a breakdown of immunological self-tolerance and causes a chronic inflammatory reaction, involving the activiation of CD4+ helper T-cells and local inflammatory release.

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7
Q

What is the histopathogenesis of rheumatoid arthritis?

A 
Unknown agent activates synovial cells.
Hypertrophy and hyperplasia of synovium.
Lymphoid follicle proliferation.
Synovial invasion.
Carilage destruction and ankylosing.
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8
Q

What are the effects of rheumatoid arthritis on the joints

A 
Thickening of synovium
Perivascular infiltrate
Increase vascularity
Aggregation of organising fibrin
Neutrophil accumulation
Osteoclasic activity
Pennus
Inflammation eventually spreads to supporting structures
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9
Q

What are the skin manifestations of rheumatoid arthritis?

A

Rheumatoid nodules (25% of patients) in areas subject to pressure

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10
Q

What other tissues can rheumatoid arthritis affect apart from joints and skin?

A

Lungs, spleen, peicardium, myocardium, cadiac valves, blood vessels (small/medium size arteries -vasculitis and rheumatoid nodules)

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11
Q

What are the clinical features of rheumatoid arthritis?

A

Insidious onset in >50% of patients
General malaise, fatigue and generalise myalgia
Joints are often involved at a later date
Affected joints present swelling, warmth, pain and stiffness in the morning or following inactive periods during the day
Progressive limitation of movements and larger number of joints involved
Natural course may be slow or rapid
Remission period

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12
Q

What joints are involved in rheumatoid arthritis?

A

Small joints of hands are usually affects first (metacarpophalangeal and proximal interphalangeal)
Wrist, ankles, elbows and knees
Lumbosacral and coxo-femoral joints are spares

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13
Q

How do you diagnose rheumatoid arthritis?

A

Based on clinical features (sometimes the only clue) including morning stiffness, rheumatoid nodules and symmetrical arthritis.
X-ray changes: narrowing of inter-articular space, cysts, porosis and erosion.

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14
Q

What are the American Rheumatoid association revised criteria for rheumatoid arthritis classification?

A 
Morning stiffness
Arthritis of three or more joint areas
Arthritis of hand joint
Symmetric arthritis
Rheumatoid nodules
Serum rheumatoid factor
Radiographic changes
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15
Q

What are some laboratory investigations for rheumatoid arthritis?

A

Full blood count (FBC): anaemia
Erythrocyte sedimentation ratio (ESR) and c-reactive protein (CRP) = raides during inflammatory process
Other tests:
o Rheumatoid factor = 80%
o Antinuclear antibodies (ANA) = 30%
o Synovial fluid aspirate = increased volume (3000 x 105 mononuclear cells)

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16
Q

What is Still’s disease?

A

Juvenile rheumatoid arthritis.
Among the most common connective tissue disorder in children.
Major cause of functional disability.
Before 16yo.

17
Q

Does Still’s disease affect more females and males?

A

2:1 female predominance.

18
Q

What are the pathogenic factors associated with Still’s disease?

A 
•	Genetic association with particular HLA haplotypes (DRBI)
•	Infections? 
     o	Mycobacterium
     o	Bacterial
     o	Viral
     o	Intestinal dysbiosis
•	Abnormal immune-regulation (activated CD+4 T lymphocytes)
•	Cytokine production
19
Q

What are the clinical features of Still’s disease?

A

Symptoms are similar to adults, but the prognosis is worse.

20
Q

What portion of Still’s disease cases are seropositive?

A

<10%

21
Q

In whom does ankylosing spondylitis usually occur

A

Usually occurs in young males at the beginning of adolescence.
90% present HLA-27 positive.

22
Q

What is the relationship between ankylosing spondylitis and rheumatoid arthritis?

A

Ankylosing spondylitis analogues to adult RA.

23
Q

What joints are involved in ankylosing spondylitis?

A

Axial joints (sacriliac joints)

24
Q

What are the clinical features of ankylosing spondylitis?

A

Patient presents with lumbar pain of a chronic nature.

1/3 of all patients present involvement of peripheral joints: coxo-femoral, knees, shoulder

25
Q

What are the complications of ankylosing spondylitis?

A

Uveitis
Aortits
Amyloidosis

26
Q

What is the pathology of ankylosing spondylitis?

A 
Destruction of articular cartilage
Bone ankylosing (sacroiliac and apophyseal joints)
Bony outgrowth on tendino-ligemantous sites
27
Q

What portion of psoriatic patients does psoriatic arthritis affect?

A

5-10%

28
Q

What age does psoriatic arthritis manifest?

A

30-50 years

29
Q

What is the onset of psoriatic arthritis?

A

Insidious onset of joint symptoms or may present an acute onset in 1/3 of cases.

30
Q

What are the clinical features of psoriatic arthritis?

A

Varied joint involvement - arthritis mutilans (rare)
DIP of hands and feet in an asymmetric fashion >50% patients
Large joints may be involved
Inflammation of digital tendon sheath = ‘sausage digit’

31
Q

What is the histopathology of psoriatic arthritis?

A

Similar to rheumatoid arthritis

Joint destruction is less frequent

32
Q

What are other areas that psoriatic arthritis can affect?

A

Spondylitis and sacroiliac joints 20-40% patients
Extra-articular: conjunctivitis, uveitis, other organs (rare)
Remission more frequent

33
Q

What is enteritis-associated arthritis induced by?

A 
Bowel infection (Shigella, Salmonela, Campylobacter)
Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
34
Q

What are the clinical features of enteritis-associated arthritis

A

Abrupt arthritic onset
Most involved joints are the knee and ankles
Sometimes wrists, finger and toes are involved
Arthritic episode may last about a year
Subjects present HLA-B27 positive

CAM102 Pathology (5 decks)

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