Rheumatology 1

Question 1

what is rheumatoid arthritis

Answer 1

Chronic autoimmune disorder that typically involves inflammation of the synovium of typical joints progressing to articular cartilage destruction

Question 2

what are the genes implicated in RA

Answer 2

• CTLA-4
• HLA DR1
• PTPN-22

Question 3

what is a major environmental factor for RA

Answer 3

smoking

Question 4

In RA, CD4+ T-cells released ? that stimulate other inflammatory cells leading to tissue injury

Answer 4

inflammatory mediators

Question 5

the key cytokines involved in RA are:

Answer 5

• INF-y
• IL-17
• TNF and IL-1
• RANKL

Question 6

IgM and IgA auto-antibodies that bind IgG Fc region, collectively referred to as ?

Answer 6

rheumatoid factor

Question 7

what is citrulline?

Answer 7

Within a protein, arginine amino acids can be converted to citrulline

Question 8

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

Answer 8

molecular mimicry

Question 9

what are the most common joints affected by RA?

Answer 9

small joints of the hands and feet ex. MCPs and PIP joints

Question 10

in RA, Characteristic morphologic features within the joint includes formation of a

Answer 10

Pannus

Question 11

what is a pannus

Answer 11

mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblast growth causing articular cartilage erosion

Question 12

Over time, after articular cartilage destruction, pannus forms a “bridge” between apposing bones forming a ?

Answer 12

fibrous ankylosis

Question 13

what is an ankylosis?

Answer 13

a “bridge” across a joint that limits range of motion

Question 14

RA tends to be symmetrically or asymmetrically distributed

Answer 14

symmetrically

Question 15

what are the two flexion-hyperextension abnormalities of the fingers in RA patients

Answer 15

swan neck and boutonniere

Question 16

Swan Neck Deformity: Due to the intrinsic hand muscle contracture
* PIPs are ?
* DIPs are ?

Answer 16

HYPEREXTEND
FLEXED

Question 17

Boutonnière (Buttonhole): due to ruptures of the central slip of the extensor tendons
* PIPs are ?
* DIPs are ?

Answer 17

FLEXED
HYPEREXTENDED

Question 18

what is the heterogenous group of disorders that Occur prior to age 16 years and persist for at least 6 weeks called

Answer 18

juvenile idiopathic arthritis

Question 19

what are the types of juvenile idiopathic arthritis

Answer 19

• systemic arthritis
• oligoarthritis
• rheumatoid-factor positive polyarthritis
• enthesitis-related arthropathy

Question 20

which arthritis has an abrupt onset, is associated with remitting, high spiking fevers

Answer 20

systemic arthritis

Question 21

what disorder is similar to adult RA, usually found in teenage girls

Answer 21

rheumatoid-factor positive polyarthritis

Question 22

what disorder is primarily found in younger males, HLA B27 positive, tends to affect joints of lower limbs and insertions of tendons

Answer 22

enthesitis-related arthropathy

Question 23

Osteoarthritis is Characterized by ? resulting in structural and functional synovial joint failure

Answer 23

articular cartilage degeneration

Question 24

OA can be either ? or ?

Answer 24

primary or secondary

Question 25

what does primary OA mean?

Answer 25

insidious onset without apparent initiating cause; considered an aging phenomenon

Question 26

what does secondary OA mean?

Answer 26

occurs in younger populations secondary to joint deformity, prior injury, or underlying systemic disease that places joints at risk

Question 27

what is the MOST common joint disease

Answer 27

osteoarthritis

Question 28

50% are significantly affected by OA by age ?

Answer 28

65

Question 29

? will proliferate to try and maintain the hyaline cartilage by increasing proteoglycan synthesis

Answer 29

Chondrocytes

Question 30

Chondrocytes also secrete ?, that degrade type II collagen

Answer 30

metalloproteases (MMPs)

Question 31

Late OA is characterized by ?

Answer 31

chondrocyte loss and severe matrix degradation

Question 32

OA is typically less ? than RA

Answer 32

symmetrical

Question 33

what are the types of infectious arthritis?

Answer 33

• suppurative
• mycobacterial
• lyme
• viral

Question 34

which arthritis is caused by Bacterial infection entering joints from distant sites via hematogenous spread

Answer 34

suppurative infectious arthritis

Question 35

what are the organisms to note for suppurative infectious arthritis?

Answer 35

○ N.Gonorrhea, Chlamydia
○ Staphylococcus, Streptococcus
○ H.influenzae, E. coli, Salmonella

Question 36

for mycobacterial infectious arthritis, chronic progressive monoarticular infections caused by ?

Answer 36

M. tuberculosis

Question 37

lyme infectious arthritis is caused by

Answer 37

spirochete, Borrelia burgdorferi

Question 38

which arthritis can occur with a variety of viral infections?

Answer 38

viral infectious arthritis