Rheumatology Flashcards
List five symptoms of Rheumatoid Arthritis (RA)
Joint pain Joint stiffness Joint swelling Functional impairment Systemic symptoms
List five signs of RA
Tenderness (pain on palpation/movement) Swelling Restriction of movement Heat and/or redness (during flare up) Systemic signs
Describe the spectrum of Rheumatic disease
Rheumatoid arthritis (RA) Sero negative arthritis Crystal arthritis (gout) Connective tissue diseases Systemic vasculitis Bone diseases
Which two auto-antibodies are associated with RA?
Rheumatoid factor
Anti-citrullinated protein antibodies (ACPA)
Describe the genetic basis of RA
Not a genetic disease but some genes increase susceptibility and risk.
Association with HLA-DRB1 locus (HLA-DR4 serotype)
What does citrullination mean?
Conversion of amino acid arginine into amino acid citrulline.
Give three non-specific systemic features of RA
Fatigue
Weight loss
Anaemia
Give five organs that can be affected by RA
Eyes Lungs Nerves Skin - rheumatoid nodules Kidneys
Give two potential complications of long term RA
Cardiovascular disease
Malignancy
How is RA assessed?
Disease activity score (DAS)
DAS < 2.4 represents clinical remission
DAS > 5.1 represents elegibility for biologic therapy
Give four therapeutic options for the RA
NSAIDs Disease modifying anti-rheumatic drugs (DMARDs) - e.g. Methotrexate Biologics Corticosteroids
Give five biologic options for the treatment of RA
TNFa inhibitors IL-1 inhibitors (Anakinra) Anti B Cell therapies (CD20, Rituximab) Anti T Cell therapies (Abatacept) IL-6 inhibitors (Tocilizumab)
Give four cytokines involved in RA pathology
TNF-alpha
IL-1
IL-6
IL-17
Describe the role of FLSs in RA pathology
Fibroblast-like Synoviocytes
- stimulate RANKL expression, which upregulated osteoclasts which causes bone erosion
- secrete proteases which degrade cartilage
Why does RA present symmetrically?
fibroblast-like synoviocytes can migrate from joint to joint
