Science of RA and clincal aspects

Question 1

What are some features of a rheumatoid joint?

Answer 1

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

Question 2

What is the synovium?

Answer 2

Soft tissue lining the spaces of diarthrodial joints, tendon sheaths and bursae
It includes the continuous surface layer of cells (intima) and the underlying tissue (subintima)

Question 3

Describe the characteristics of the rheumatoid synovitis.

Answer 3

Inflammatory cell ,T cells, B cells infiltration
Synoviocyte proliferation
Neoangiogenesis

Question 4

What is RF?

Answer 4

Rheumatoid factor

Antibody associated with RA

Question 5

What are some features of seropositive RA?

Answer 5

RF
Anti-citrullinated protein antibody
Less favourable prognosis

Question 6

What are some genes associated with RA?

Answer 6

HLA-DRB1
PTPN22
CTLA4

Question 7

What are some environmental risk factors for RA?

Answer 7

Smoking
Infection (EBV, E coli, Mycoplasma, periodontal disease)
Repeated insults

Question 8

Why is there neoangiogenesis in RA?

Answer 8

Induced by local hypoxic conditions and cytokines

Question 9

What is a good drug for RA?

Answer 9

Rituximab

Question 10

What are some systemic consequences of RA?

Answer 10

Osteopenia
Sarcopenia
Sjorgen's syndrome
Interstitial lung disease
Fibrosis
Fatigue
Weight loss
Anaemia

Question 11

How is RA investigated?

Answer 11

Immunology
RF (IgG, IgM)
ACPA
X-ray

Question 12

What are some common symptoms of RA?

Answer 12

Pain
Stiffness
Immobility
Poor function
Systemic

Question 13

What are some common clinical signs of RA?

Answer 13

Swelling
Tenderness
Limitation of movement
Redness
Heat

Question 14

What is the DAS?

Answer 14

Disease Activity Score
<2.4 indicates clinical remission
>5.1 indicates eligibility for biologic therapy