Rheumatology 1 Flashcards
what is rheumatoid arthritis
Chronic autoimmune disorder that typically involves inflammation of the synovium of typical joints progressing to articular cartilage destruction
what are the genes implicated in RA
- CTLA-4
- HLA DR1
- PTPN-22
what is a major environmental factor for RA
smoking
In RA, CD4+ T-cells released ? that stimulate other inflammatory cells leading to tissue injury
inflammatory mediators
the key cytokines involved in RA are:
- INF-y
- IL-17
- TNF and IL-1
- RANKL
IgM and IgA auto-antibodies that bind IgG Fc region, collectively referred to as ?
rheumatoid factor
what is citrulline?
Within a protein, arginine amino acids can be converted to citrulline
In B, a microbial infection sensitizes CD4+ cells that are capable of recognizing self
* The microbial antigen resembles the self-antigen
* Since an infection triggers PRRs, then the APC expresses costimulatory molecules -> T-cell activation instead of anergy
This process is known as
molecular mimicry
what are the most common joints affected by RA?
small joints of the hands and feet ex. MCPs and PIP joints
in RA, Characteristic morphologic features within the joint includes formation of a
Pannus
what is a pannus
mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblast growth causing articular cartilage erosion
Over time, after articular cartilage destruction, pannus forms a “bridge” between apposing bones forming a ?
fibrous ankylosis
what is an ankylosis?
a “bridge” across a joint that limits range of motion
RA tends to be symmetrically or asymmetrically distributed
symmetrically
what are the two flexion-hyperextension abnormalities of the fingers in RA patients
swan neck and boutonniere
Swan Neck Deformity: Due to the intrinsic hand muscle contracture
* PIPs are ?
* DIPs are ?
HYPEREXTEND
FLEXED
Boutonnière (Buttonhole): due to ruptures of the central slip of the extensor tendons
* PIPs are ?
* DIPs are ?
FLEXED
HYPEREXTENDED
what is the heterogenous group of disorders that Occur prior to age 16 years and persist for at least 6 weeks called
juvenile idiopathic arthritis
what are the types of juvenile idiopathic arthritis
- systemic arthritis
- oligoarthritis
- rheumatoid-factor positive polyarthritis
- enthesitis-related arthropathy
which arthritis has an abrupt onset, is associated with remitting, high spiking fevers
systemic arthritis
what disorder is similar to adult RA, usually found in teenage girls
rheumatoid-factor positive polyarthritis
what disorder is primarily found in younger males, HLA B27 positive, tends to affect joints of lower limbs and insertions of tendons
enthesitis-related arthropathy
Osteoarthritis is Characterized by ? resulting in structural and functional synovial joint failure
articular cartilage degeneration
OA can be either ? or ?
primary or secondary
what does primary OA mean?
insidious onset without apparent initiating cause; considered an aging phenomenon
what does secondary OA mean?
occurs in younger populations secondary to joint deformity, prior injury, or underlying systemic disease that places joints at risk
what is the MOST common joint disease
osteoarthritis
50% are significantly affected by OA by age ?
65
? will proliferate to try and maintain the hyaline cartilage by increasing proteoglycan synthesis
Chondrocytes
Chondrocytes also secrete ?, that degrade type II collagen
metalloproteases (MMPs)
Late OA is characterized by ?
chondrocyte loss and severe matrix degradation
OA is typically less ? than RA
symmetrical
what are the types of infectious arthritis?
- suppurative
- mycobacterial
- lyme
- viral
which arthritis is caused by Bacterial infection entering joints from distant sites via hematogenous spread
suppurative infectious arthritis
what are the organisms to note for suppurative infectious arthritis?
○ N.Gonorrhea, Chlamydia
○ Staphylococcus, Streptococcus
○ H.influenzae, E. coli, Salmonella
for mycobacterial infectious arthritis, chronic progressive monoarticular infections caused by ?
M. tuberculosis
lyme infectious arthritis is caused by
spirochete, Borrelia burgdorferi
which arthritis can occur with a variety of viral infections?
viral infectious arthritis
