science of rheumatoid arhritis

Question 1

functions of synovium

Answer 1

maintenance intanct tissue surface

lubrication cartilage

control synovial volume and composition

nutrition of chondrocytes within joints

Question 2

features of joint with rheumatoid arthritis

Answer 2

erosion into corner of bone
thinning of cartilage
inflamed synovium
inflamed tendon sheath

Question 3

definition of rheumatoid arthritis

Answer 3

chronic symmetric polyarticular inflammatory joint disease

primarily affects small joints of hands and feet

Question 4

rheumatoid synovitis

Answer 4

leads to formatino of pannus

inflammatory cell infiltration, synoviocyte proliferation and neoangiogenesis (formation new blood vessels)

Question 5

synovial pannus

Answer 5

causes bone and cartilage destruction (–> deformities)

Question 6

what type of disease is RA

Answer 6

immune-mediated/autoimmune

Question 7

what autoantibodies are commonly associated with RA

Answer 7

rheumatoid factor (RF)

anti-cirtullinated protein antibodies

Question 8

what due autoantibodies in RA recognise

Answer 8

joint antigens e.g. type II collagen

or

systemic antigens e.g. glucose phosphate isomerase

Question 9

autoantibody production in seropositive rheumatoid arthritis

Answer 9

rheumatoid factor
anti-citrullinated protein antibody (ACPA)

diagnostic anti-CCO assays recognise cirtullinated sel-proteins

Question 10

do patients with ACPA+ disease have more or less favourable prognosis

Answer 10

less

Question 11

seronegative rheumatoid arthritis

Answer 11

no detectable autoantibodies

Question 12

what is rheumatoid factor an autoantibody to

Answer 12

self IgG Fc

Question 13

environmental risks for RA

Answer 13

smoking + bronchial stress

infectious agents: e.coli, mycoplasma, periodontal disease, gut microbes

Question 14

repeated environmental insults in a genetically susceptible individual would lead to

Answer 14

formation of immune complexes and rheumatoid factor (high affinity autoAb against Fc portion of Ig)

altered citrullination of proteins and breakdown of tolerance, resulting in ACPA response

Question 15

what is citrullination

Answer 15

conversion of amino acid arginine into amino acid citrulline

Question 16

pathogenesis of RA

Answer 16

synovitis - inflammation of synovium

villous hyperplasia
infiltration T cells, B cells, macrophages, plasma cells
intimal cell proliferation (fibroblasts)
production cytokines and proteases
increased vascularity

self-amplifying process

Question 17

systemic complications of RA

Answer 17

vasculitis, nodules, scleritis, amyloidosis: chronic inflammtion

CVS disease

fatigue and reduced cognitive functin

interstitial lung disease, fubrosis

oteoporosis