Session 8 RA Flashcards
Rheumatic diseases are characterized by inflammation connecting or supporting structures of the body — most commonly the joints. Give examples:
Osteoarthritis (most common arthritis) - affects and destroys cartilage
Rheumatoid arthritis (AID) - synovium
Fibromyalgia - a chronic condition marked by tender points and localized pain throughout the musculoskeletal system
Systemic lupus erythematosus (AID) - joints, skin, kidneys, blood, lungs, heart, and brain
Gout - a type of arthritis, uric acid deposit in the joints (big toe)
Infectious arthritis (arthritis that’s caused by an infection) e.g. Lyme disease or Neisseria gonorrhoeae,
Psoriatic arthritis (a type of arthritis) that affects the fingers and toes and is associated with psoriasis
Ankylosing spondylitis, ( most common spondyloarthropathy) , which may affect the hips, shoulders, and knees, in addition to the spine
Reactive arthritis, or Reiter’s syndrome, (spondlyoarthropathy) that develops after an infection of the urinary tract, bowels, or other organs
- Cause of rheumatic diseases?
- Various factors can put you at greater risk for developing one or more rheumatic diseases. For example:
A. Osteoarthritis is more common in older adults than younger adults
B. Women are far more likely than men to develop ?
C. Gout and spondyloarthropathies are more common in men
D. Lupus most often affects African-Americans and Hispanics
E. Obesity and smoking increases your risk for a number of rheumatic diseases
F. Dietary factors may increase or decrease your risk for certain rheumatic diseases — gout is associated with ?
- Gene & environment e.g. for rheumatoid
2B. rheumatoid arthritis, scleroderma, fibromyalgia, and lupus
F. diets high in purines, which are found in various types of meat
- For arthritis, inflammation typically causes one or more symptoms in the joints, including:
- Rheumatic diseases may produce a wide variety of other symptoms, such as:
- What is rheumatism
1. Pain, Stiffness, especially in the morning
Swelling
Warmth and redness
Tenderness
Difficulty using the joint normally
- Fatigue
Eye inflammation or infections
Rashes and sores
Pain in the neck, spine, or back
Difficulty taking a deep breath
Muscle pain
- any disease marked by inflammation and pain in the joints, muscles, or fibrous tissue,
Give examples of autoimmune rheumatoid diseases
- Pain on its own (in joint) =
- Pain and swelling (in joint) =
- What is Palindromic rheumatism (PR) ?
- ARD can mimic?
- Arthralgia
- Arthritis
- attacks of arthritis (in lecture he said attacks can occur in a pattern e.g. shoulder elbow wrist ankle then back up)
- acute pain, redness, swelling, and disability of one or multiple joints
- interval between & the length of an attack is extremely variable from few hours to days.
- no joint damage after attacks.
- It is thought to be an autoimmune disease, possibly an abortive form of rheumatoid arthritis.
- attacks of arthritis (in lecture he said attacks can occur in a pattern e.g. shoulder elbow wrist ankle then back up)
- Malignancy and vice versa
What to check for in history of lupus?
History taking for ARDs (lupus)
• Constitutional symptoms
(Fever, fatigue, weight loss, night sweats, Poor appetite)
• “Glove and sweater” approach
Examination for lupus
Investigations for lupus
Features of lupus
Rheumatoid arthritis (RA) History
- Female to male ratio: 3:1
- Prevalence: 1%
- No race predilection
- Genetic factors/environmental factors
Current symptoms • Pain • Stiffness • Swelling • Pattern of joint involvement
Evolution • Acute or chronic? • Associated events • Response to treatment/Family history
Involvement of other systems • Skin, eye, lung • Malaise, weight loss, fevers, night sweats?
Impact on patient’s lifestyle
Investigations for RA
Anti-Cyclic Citrullinated Peptide
- Ra pathogenesis
- Image
What do you autoantibodies do you find in blood tests?
What other test do you perform for RA
What can occur in the lungs?
Name 2 extra articular manifestations
- What type of hypersensitivity reaction is lupus?
- State the pathogenesis
- Type 3
-
apoptosis (natural or environment)
- Small blebs that carry self antigens e.g. nuclear constituents (e.g. DNA and histones)
- phagocytosis is ineffective - susceptibility genes - not removed from the blood
- transferred to lymphoid tissues, where they can be taken up by antigen-presenting cells
- The self antigens presented to T cells (TH4) -> B cells to produce autoantibodies
-
apoptosis (natural or environment)
The combination of availability of self antigens and failure of the immune system to inactivate B cells and T cells that recognize these self antigens (i.e. a breakdown of tolerance) leads to the following immunological consequences:
- Development of autoantibodies that either form circulating complexes or deposit by binding directly to tissues.
- Activation of complement and influx of neutrophils, causing inflammation in those tissues.
- Abnormal cytokine production
What occurs once the antigen - antibody complexes have been made?
Deposit in various tissues e.g.
What are the main auto-antibody found in blood tests?
What other autoantibodies can occur in SLE?
Antinuclear antibodies (E.g. Anti DNA (or anti double stranded DNA))
Anti-Sm antibodies
Antiphospholipid antibodies
The SKIN is commonly involved? Give three features:
Butterfly rash on face
Photosensitivity
Urticaria
Vasculitis
Purpura