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Year 3 MSK pathologies > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is rheumatology?

A

Deals with the management of athritis and other related conditions. This includes more than 200 disorders including inflammatory arthritis, connective tissue disease and bone disease.

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2
Q

What is athritis

A

Inflammation of the joints

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3
Q

What are the signs of arthritis?

A 
Tenderness
Swelling
Restriction of movement
Heat
Redness
Systemic features
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4
Q

What are the symptoms of arthritis

A 
Pain
Stiffness
Swelling
Functional impairment
Systemic symptoms
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5
Q

What is the spectrum of rheumatic disease

A 
RA
Sero-negative 
Crystal
Connective tissue diseases
Systmeic Vasculitis
Bone disease
Osteoarthritis
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6
Q

What is the role of the synovium?

A

maintenance of intact tissue surface
lubrication of cartilage
control of synovial fluid volume and composition (hyaluronan, lubricin)
nutrition of chondrocytes within joints

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7
Q

What are some pathologies that can occur in a rheumatoid joint?

A

Thinning of articular cartilage
Erosion into corner of bone
Inflamed synovium
Inflamed tendon sheath

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8
Q

What is the definition of rheumatoid arthritis

A

Chronic symmetric polyarticular inflammatory joint disease which primarily affects the small joints of the hands and feet.
Characterised bu inflammatory cell inflitration, synoviocyte proliferation and neoangiognesis
Synovial joint cavity contains neutrophils, particularly during acute flares of RA
Leads to bone and cartilage destruction

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9
Q

What is meant by autoimmunity in those with rheumatoid arthritis

What autoimmune cells are present in RA

A

Cells that attack the bodies joints, can be present years before clinical symptoms of actual arthritis.

RF’s,anti-cirullinated protein antibodies
Recognise joint antigens (type II collagen)
Recognise systemic antigens (glucose phosphate isomerase)

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10
Q

What antibodies are produced in seropositive rheumatoid arthritis?

What is rheumatoid factor an autoantibody to?

A

Rhuematoid factor
Anti-citrullinated protein antibody (ACPA)
Diagnostic anti-CCP assays recognise a-ebclose, keratin, fibrinogen, fibronectin,collagen vimentin

Self IgG Fc

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11
Q

What genes play a role in RA and disease severity

A

Many many genes

Class II major histocompatibility, PTPN 22
HLA-DRB1
CTLA4

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12
Q

What environmental factors are attributed to developing RA

A

Smoking and bronchial stress

Infectious agents- viruses, e.coli, mycoplasma, peridontal disease, gut microbes

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13
Q

What does repeated genetic insults lead to in RA

A

Formation of immune complexes and rheumatoid factor

Altered citrullination of proteins and breakdown of tolernce, with resulting ACPA response

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14
Q

What is citrullination

A

The conversion of amino acid arginin einto the amino acid citrulline.

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15
Q

How do environmental factors cause susceptibility to RA

A

They cause epigenetic modification and activate succeptile genes, leading to self protein citrullinaiton

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16
Q

What is the immunology behind synovitis in RA

A

Infiltration od mononucleur cells, especially CD4+ T cells, macrophages and B cells
Lining FLS poliferate becoming aggrivated.
Macrophages are activated
lymphocytes diffues in
Antigen T cells are presented to synovial germinal centres

17
Q

What is the simplified immunology behind synovitis in RA?

A 
Villous hypreplasia
Infiltration of T cells, B cells, macrophages and plasma cells
Intimal cell proliferation (fibroblasts)
Production of cytokine and proteases
Increased vascularity
Self amplifying process
18
Q

What is the role of inflammatory cytokines on this process

A

Induce expression of endothelial cell adhesion molecules.
Activate synovial fibroblasts, chondrocytes, osteoclasts
Promote angiogenesis
Suppress T-regs
Activate leukocytes
Il-6 mediates systemic affects

19
Q

What occurs during neroangiogenesis?

A

Provides nutrients to the hyperplastic synvoium

Hypoxic conditions and angiogenic factors such as IL-8 and VEGF enhance blood vessel proliferation in the synovium

20
Q

How are the bone and cartilage destroyed?

A

Several classes of proteases iincluding metalloproteinases and aggrecanases are produced
Synovial lining cells can attach to and invade cartilage in RA

Bone destruction is mediated by osteoclasts that are activated under the influence of RANKL produced by RA in synovium

21
Q

What are the systemic consequences of rheumatoid arthritis

A 
Vascultits, nodules, cleritis, amyloidosis 
Cardiovascular disease
Fatigue and reduced cognitive function
Liver
Lungs-ILDm fibrosis
sarcopenia
Osteoperosis
Secondary sjorgen's sydrome
22
Q

What cytokine networks participate in disease perpetuation

A

TNF-a, IL-6

23
Q

How is bone and cartilage destruction primarily mediated?

A

Osteoclasts and fibrobalst like synoviocytes

Year 3 MSK pathologies (34 decks)

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