the medicine Flashcards
what are clinical presentations of rheumatoid arthritis
RA
amthmitis -
symmetrical
swelling
nodules
hand involvement early and in disease -
MCP and PiP joints
describe the joints in the hand
RA
closer to wrist: DIP
middle: MCP
closest to fingertips: PIP
what happens in swan neck as disease progresses
RA
PIP if hyper extended
DIP is flexed
what happens in boutonniere as disease progresses
RA
PIP is flexed
DIP is hyper extended
what is synovitis
RA
inflammation of the synovial membrane
causing pain and swelling
leading to bone and cartilage breakdown and erosion
what is z deformity of the thumb, ulnam deviation
as disease progresses RA
a side effect of progressing RA
what do macrophages do in RA cellular level
secrete cytokines
TNF alpha
Interlukin-1
Interlukin-6
all leading to inflammation
what do the cytokines secreted by the macrophage stimulate
RA
FIBROBLAST II - LIKE SYNIOVITES (FLS)
activates them
proliferate
stimulates RANKL expression along with the cytokines to stimulate osteoclast activty (bone arthritis)
what happens when FLS are stimulated
RA
secretes proteases
cause cartlage to break down
cartilage degredatin
cartilage also secretes proteases
how do we get symmetrical arthritis in RA
FLS can migrate from joint to joint
what do T cells in the synovium do
RA
secrete interlukin-17 which can promote macrophage activity and stimulate FLS
also help in expression of RANKL
what do plasma cells do
RA
stimulate inflammation through cytokines and antibodies
what do neutrphils do in the synovium fluid
RA
produces proteases and recative O2 species
lead to bone and cartilage degredation
what do immune complexes in the synovium fluid do
RA
abs that bind to one another
promote inflammation
what is angiogenesis
RA
increases vacular permeability
increases adhesion molecules
allowing immune cells to migrate into the joints
tell me about pre rheumatoid arthritis
genetics
smoking
porphyromungs gingivitis leading to gingivitis
cause modification of autuantigens
what is modification of autuantigens in RA
mod of own antigens to make it seem foreign to own body, leading to immune response
inflammation can aslo lead to this
APC initiate immune response, goes to lumph node, activates T cells here, CD4, activates B cells (costimulation), proliferate, plasma cells, produce autuantibodies, against own antigen. migrates to joint tissue.
what are the two main abs in RA
rheaumatoid factor IGM and anti citrulinated protein ab
wat is the IGM abs in RA
persesnt in 75% of ppl with IGM
forms immune complexes
what does anti citrullinated ab do in RA
targets citrullenated proteins such as fibrin and fillagbin
more specific for RA
what happens with the cytokines in the blood
RA
increase of inflammatory cytokines in the blood
skin - nodules
liver - more CRP inflammotory marker, more hepctoin = anaemia
CV - plaque formation, MI/stroke
neurological - fatigue and depression
muscles - insulin resistance, muscle weakness
What blood tests will the GP order given the suspected diagnosis of RA?
FBC, RF, ANA, CRP, ESR, Kidney and Liver function, anti-CCP*
*Negative results and normal inflammatory markers do not exclude the diagnosis in the presence or a good history and examination findings.
Should Mrs Montoya follow a specific diet to help with her
suspected new diagnosis?
No specific diet has been evidenced to help; encourage Mediterranean diet
NSAIDs can cause peptic ulceration. Will the EC coating prevent this adverse effect. Explain your reasoning.
No. Systemic inhibition of COX-1, a key enzyme involved in prostaglandin biosynthesis; inhibition of prostaglandin mediated alkaline mucus secretion which protects GI epithelium.
In summary, while enteric coatings on NSAIDs can help reduce the risk of peptic ulceration by protecting the stomach lining from direct irritation, they may not completely eliminate the risk. It’s essential for healthcare providers to consider individual patient factors and closely monitor patients who are at higher risk for GI complications when prescribing NSAIDs, regardless of whether they are enteric-coated or not.