Rheumatology Flashcards
What is a chronic inflammatory disease of unknown etiology marked by symmetric polyarthritis
Rheumatoid Arthritis
What is the most common form of chronic inflammatory arthritis
Rheumatoid Arthritis
What are the 2 laboratory test used for diagnostic and prognostic Biomarkers of Rheumatoid Arthritis
ACPA and RF
Incidence of RA increases between ages of_____________plateaus until the age of ___________ and decreases after __________ of age
25-55 years
75 years
After 75 years
How many Joints:
1. Oligoarticular
2. Polyarticular
- <=4
- > =5
Too few affected joints to be classified as RA is known as?
Undiffirentiated Inflammatory Arthritis
Most frequently involved joint in RA
Wrist, MCP, PIP
Involvement of this joint may indicate coexisting osteoarthritis in RA
DIP (Distal Interphalengeal Joints)
What is the frequent hallmark of RA
Flexor Tensynovitis
Subluxation of MCP joints + subluxation of proximal phalanx to volar side of the hand
Ulnar Deviation
Hyperextension of tge PIP joint with flexion of the DIP joint
Swan Neck deformity
Flexion of PIP joint with hyperextension of DIP joint
Boutonniere deformity
Subluxation of First MCP joint + hyperextension of the first IP joint
Z-line deformity
Inflammation of the ulnar styloid + tensynovitis of the extensor carpi ulnaris causing subluxation of distal ulna
“Piano-key Movement” of Ulnar Styloid
In RA, Antlantoaxial involvement of cervical spine increases the risk of?
Compressive Myelopathy and Neurologic Dysfunction
RA rarely affects the?
Thoracic and Lumbar Spine
In RA, Affectation of this Joint is mostly seen as radiographic abnormality but rarely with significant symptoms or functional impairment
TMJ
Risk factors that will most likely manifest with extraarticular manifestations in RA
- Cigarette smoking
- Early onset of significant physical disability
- Positive RA or ACPA
In RA, if patient has fever of more than 38.3 c (101F) you will suspect?
- Systemic Vasculitis
- Infection
10% of patients with RA have?
Sjögren’s Syndrome
Keratoconjunctivitis Sicca and Xerostomia is present in?
Sjögren’s Syndrome
Most common pulmonary manifestation in RA
Pleuritis
Presents with dry cough and progressive SOB, confers poor prognosis in RA
Interstitial Lung Disease
This shows a progressive scarring of the lungs seen on chest CT scan as honeycomb changes in the periphery and lower portion of the lungs?
Usual Interstitial Pneumonia
Relatively symmetric and bilateral ground glass opacities with associated fine reticulations, with volume loss and traction bronchiectasis?
Non Specific Interstitial Pneumonia
Pulmonary Function Test result of Interstitial Lung Disease?
Restrictive Pattern:
- Reduced TLC
- Reduced DLCO
Pulmonary Nodules + pneumoconiosis following Silica exposure?
Caplan’s Syndrome
Most frequent site of cardiac involvement in RA
Pericardium
Most common Valvular abnormality in RA
Mitral Regurgitation
Most common hematologic abnormality in RA
Normochromic, Normocytic Anemia
Triad of Felty’s Syndrome
- Neutropenia
- Spleenomegaly
- Nodular RA
Due to aggressive treatment for RA there is noted decreased incidence of?
Felty’s Syndrome
Differential diagnosis for Felty’s Syndrome due to similar presentation and may develop early in RA as opposed with Felty’s syndrome which usually occur during the late course of RA?
T Cell large granular lymphocyte Leukemia (T-LGL)
Most common histopathologic type of lymphoma in RA
Diffuse Large B cell lymphoma (DLBCL)
Most common cause of death in RA?
Cardiovascular Disease
This Fracture is more likely to occur in RA due to chronic glucocorticoid use and/or disability -related immobility
Hip Fracture
This is most common in RA than in age and sex matched population?
Osteoporosis
Likelyhood of RA if with first degree relative with RA
2-10x
Heretibility of RA is?
40-50%
MHC Alleles known to confer the greatest risk of RA
Located within MHC class II
Epigenetic mechanisms that are theoretically involved in three important aspects of RA
- Disease etiology
- Perpetuation of chronic inflammatory responses
- Disease severity
Best studied epigenetic mechanism in RA?
Post translational histone modifications and DNA methylation
Most reproducible of the environmental links implicated in the pathogenesis of RA
Cigarette Smoking
Risk of RA persist even after ______years of smoking cessation
15
The bacteria in periodontis can trigger RA development, what bacteria is it?
Porphyromonas Gingivalis
(P. Gingivalis)
Type A Synoviocytes
Macrophage-derived
Type B synoviocytes
Fibroblast derived
Pathologic Hallmark of RA
Synovial inflammation and proliferation, focal bone erosions, articular cartilage thinning
What is Pannus?
Thickened cellular membrane containing fibroblast-like synoviocytes and granulation reactive fibrovascular tissue that invades the underlying cartillage and bone
What are the 3 bone loss types in RA
- Osteoclast-mediated bone erosions
- Periarticular osteopenia
- Generalized osteoporosis
Induced structural damage to the mineralized cartilage and subchondral bone
Osteoclast
Bone erosion in joints with active inflammation, characterized by thinning of the bony trabeculae
