RHEUMATOLOGY REVIEW- short Flashcards
Sports: in general, no increased risk; exercise may be _________ in OA
protective
Cartilage in early Osteoarthritis MMPS
Increased metalloproteinases
Osteoarthritis Factors
Interleukin-1 Nitric oxide Prostaglandins Complement activation Adipokines
Rheumatoid Arthritis (RA)– A systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a peripheral, ____________ which can result in cartilage and bone destruction
symmetric synovitis
Rheumatoid Arthritis– Disease susceptibility and severity associated with shared epitope (QKRAA; in antigen binding groove) in subtypes of __________
HLA-DR4 and HLA-DR1;
Rheumatoid Arthritis– RF-IgG immune complexes are _____________
pathogenic
____________: modulation and amplification of local immune response through antigen recognition (query altered proteoglycans or collagen; citrullinated peptides)
CD4+ memory T cells- Rheumatoid Arthritis
Gout– The result of tissue deposition of monosodium urate (MSU) crystals due to hyperuricemia (MSU ___________ of extracellular fluids)
supersaturation
Hyperuricemia: over-production or under-excretion of uric acid; ______________ (90%)
underexcretors
Uric acid is a product of ___________ metabolism:
purine
Humans lack _________ which oxidizes uric acid into allantoin
uricase
Overproduction of uric acid (X-linked):
PRPP synthetase ___________
HGPRT deficiency (complete: Lesch-Nyhan)
overactivity
Crystal arthritis is diagnosed by arthrocentesis and crystal identification by polarized microscopy (MSU crystals: ______________)
needle-shaped, negatively birefringent
_________ promotes phagocytosis by PMNs
IgG: not specific anti-crystal antibodies
Apolipoprotein B-coating inhibits phagocytosis
IgG-coating
Overproduction of uric acid (X-linked):
PRPP synthetase overactivity
HGPRT __________ complete: Lesch-Nyhan)
deficiency
Crystal arthritis is diagnosed by ___________ and crystal identification by polarized microscopy (MSU crystals: needle-shaped, negatively birefringent)
arthrocentesis
IgG-coating promotes phagocytosis by PMNs
IgG: not specific anti-crystal antibodies
______________ inhibits phagocytosis
Apolipoprotein B-coating inhibits
Seronegative Spondyloarthropathies- Axial arthritis: spine, SI joints (__________); morning (am) stiffness
sacroiliitis
Seronegative Spondyloarthropathies
_______- ligamentous-, tendinous-, fibrous-osseous junctions
Enthesitis:
Seronegative Spondyloarthropathies Synovium: increased expression of_________
TNFalpha
HLA-B27 genetic association; neg RF and ANA
Chance of developing AS:
2% if HLA-B27 positive
20% if HLA-B27 positive with a ___________
first-degree relative with AS
Asymmetric, oligoarticular, lower ext arthritis
Reactive Arthritis- Bacterial environmental triggers transported to the joints inside monocytes (Chlamydia can be latent):
Systemic Lupus Erythematosus (SLE)- Fundamental defect is the _________________, resulting in an autoimmune process; T cell and B cell process
misdirected recognition of self as foreign
Systemic Lupus Erythematosus (SLE)- Antibody responses toward autoantigens are antigen-driven and ___________
require CD4+ T cells
Chance of developing AS:
2% if ____________
20% if HLA-B27 positive with a first-degree relative with AS
HLA-B27 positive
Loss of T cell tolerance permitting autoreactive B cell stimulation: ? central or ________________ abnormality in self-reactive lymphocyte deletion or anergy
peripheral
Systemic Lupus Erythematosus (SLE)- Association with HLA-DR3 and ___________ (greatest risk)
C4A null allele
Systemic Lupus Erythematosus (SLE)- Fundamental defect is the misdirected recognition of self as foreign, resulting in an autoimmune process; _________________
T cell AND B cell process
Loss of T cell tolerance permitting autoreactive B cell stimulation: ? central or peripheral abnormality in ____________ lymphocyte deletion or anergy
self-reactive
SLE: > 95% patients have + ANAs
Not specific for SLE: can occur in other CTDs
Antibodies are directed to _____________
multiple nuclear antigens
Anti-dsDNA antibodies: renal disease
Anti-histone antibodies: SLE and drug-induced lupus
Antibodies to non-DNA, non-histone nuclear antigens:
SLE- Anti-phospholipid antibodies: block prothrombin activation in the clotting cascade; associated with increased ___________;
clotting
Vasculitis: Immune complexes: inflamm→ PAFs→ ↑vascular permeability→ IC deposition; ___________
palpable purpura
Cytoplasmic ANCA (c-ANCA):
Proteinase-3 (PR3) in primary granules of PMNs
Associated with generalized GPA (Wegener’s)
Perinuclear ANCA (p-ANCA):
Myeloperoxidase (MPO) in primary granules of PMNs
Associated with microscopic polyangiitis (MPA)
ANCA Vasculitis
Antineutrophil Cytoplasmic Antibodies (ANCAs):
Vasculitis: Immune complexes: inflamm→ PAFs→ ↑____________→ IC deposition; palpable purpura
vascular permeability
Anti-synthetase Syndrome
PM or DM presenting with:
Interstitial lung disease (ILD): 60%
Anti-Jo-1 = anti-histadyl-tRNA synthetase
Not pathologic or myotoxic antibodies
Endomysial distribution of inflammatory cells (CD8+ T cells) surrounding and invading muscle fibers
Polymyositis
Perivascular (CD4+ T cells) and perifascicular inflammatory infiltrate
Dermatomyositis
