Rheumatoid Arthritis-Hudig

Question 1

WHat is rheumatoid arthritis defined as?

Answer 1

synovitis in 1 or more joints

score greater than 6

Question 2

What is the scoring system for arthritis?

Answer 2

Score = or > 6 for
Number and sites of the involved joints, 0-5 points
Serology, 0-3 points
Elevated acute phase response (APR), 0-1 points
Duration of symptoms, 0-1points

Question 3

What are some lab indicators of rheumatoid arthritis?

Answer 3

RA synovial lymphocytes >2000
anti-citrullinated peptide antibody
synovial fluid turbid, yellow, neutrophils present. No crystals!

Question 4

What are some systemic manifestations of rheumatoid arthritis?

Answer 4

generalized fatigue
low grade fever
C-reactive protein
**maybe vasculitis, pleurisy, pericarditis

Question 5

What are the 4 criteria the trust be met for autoimmunity?

Answer 5

auto antigens involved in the disease
anti-self immunity with immune mediators of damage
immunogenetics & therpaeutics

Question 6

What are some of the microscopic features of rheumatoid arthritis?

Answer 6

finger-like protrusions into synovium
**they are inflamed fibrovascular stroma
covered in epithelial cells
hyperplasia of synoviocytes
inflammatory cells present

Question 7

What are the 4 types of immune cells involved in rheumatoid arthritis?

Answer 7

CD4 TH1
CD4 TH17
CD4 Treg
NK cells
Note: CD8 not involved

Question 8

What are the 5 major cell types found in an RA lesion?

Answer 8

Dendritic Cells (APC)
T cells
B Cells
Macrophages
Neutrophils

Question 9

Describe the process that begins with APC in rheumatic lesion & ends with recruitment of neutrophils.

Answer 9

APC bind antigen.
Activates CD4 THO Cell.
Secretes IL6 & TGF beta
Activates CD4 TH17
Releases IL-17
IL-17 binds fibroblasts.
They release CXCL2 & CXCL8
Neutrophils recruited!

Question 10

Which T cells are found in rheumatic lesions?

Answer 10

CD4 TH1
CD4 TH17
CD4 T reg

Question 11

What are some important antibodies produced by B cells?

Answer 11

RA

anti-citrullinated peptide antibody

Question 12

Describe the process that begins with macrophages & ends with activated osteoclasts.

Answer 12

CD4 activates macrophages.
Cytokines released.
Fibroblasts activated & they release MMP & RANK.
Osteoclasts active.

Question 13

What are the 4 major cytokines seen in rheumatic lesions?

Answer 13

TNF alpha
IL-1
IL-6
IL-17

Question 14

What is the process of citrullination?

Answer 14

post-translational modification that converts arginine into citrulline
carried out by intracellular enzyme: PAD

Question 15

What is an important protein that gets citrullinated in rheumatoid arthritis?

Answer 15

Vimentin, also collagen
intermediate filament protein
gets citrullinated during cell death or inflammation

Question 16

What is the sensitivity & specificity of the APCA test for rheumatoid arthritis?

Answer 16

sens: 70%
Spec: 99%

Question 17

What is the structure of rheumatoid factor?

Answer 17

IgM or IgA antibody against Fc portion of IgG

Question 18

What is the sensitivity & specificity for testing RF?

Answer 18

sens: 70%
spec: low b/c also seen in lupus

Question 19

What is epitope spreading?

Answer 19

immune reaction changes from targeting one epitope to multiple epitopes
seems to happen with citrullination in RA

Question 20

Which cytokines do glucocorticoids reduce when treating RA?

Answer 20

IL-1

TNFalpha

Question 21

Which RA treatment reduces T & B cell expansion?

Answer 21

methotrexate

Question 22

Biologic DMARDs block which cytokines usu?

Answer 22

TNFalpha

IL-6

Question 23

Why is it good to block IL-6 with a biologic DMARD?

Answer 23

then you don’t get TH17 activation & secretion of IL-17 & recruitment of neutrophils