The science of rheumatoid arthritis Flashcards

1
Q

What happens to the joint in rheumatoid arthritis

A

Inflammation of the synovium due to inflammation - synovitis

The synovitis leads to the erosive damage of the bone and cartilage - on Xray the erosive damage is seen as marginal erosions

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2
Q

What is the definition of rheumatoid arthritis

A

Chronic, symmetric, polyarticular (5 or more joints) inflammatory joint disease that affects the small hands of the hands and feet

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3
Q

What is the rheumatoid synovitis characterised by

A

inflammatory cell infiltration - fibroblast proliferation and neoangiogenesis - development of new blood vessels

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4
Q

What does the synovial fluid in the joint cavity contain - especially in acute cases of rheumatoid arthritis

A

neutrophils

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5
Q

What antibodies are associated with rheumatoid arthritis

A

RFs - rheumatoid factors - and anti-citrullinated protein antibodies

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6
Q

Which antibodies are checked on suspected rheumatoid arthritis

A

Rheumatoid factor and anti-CCP antibodies

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7
Q

What is seropositive arthritis

A

they test positive for either rheumatoid factor or anti-CCP antibodies

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8
Q

What is seronegative rheumatoid arthritis

A

Testing negative for rheumatoid factor or anti-CCP antibodies - has a better prognosis

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9
Q

What gene is rheumatoid arthritis associated with

A

HLA-DRB1 locus

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10
Q

What enviromental factors can cause rheumatoid arthritis

A

smoking and bronchial stress - e.g exposure to silica

Infectious agents like viruses

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11
Q

What is citrullination

A

Conversion of amino acid arginine into the amino acid citrulline

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12
Q

How does citrillation lead to rheumatoid arthritis

A

When there is excessive citrullation, antigens form that can cause the formation of autoantibodies

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13
Q

What happens in synovitis in rheumatoid arthritis

A

Intimal lining hyperplasia and sublining infiltration of mononuclear cells - mainly immune and inflammatory cells
Macrophages in the lining are then activated
Fibroblasts proliferate
Synovial B cells produce antibodies
Dendritic cells present anigens to T cells in synovial germinal centres
Hypoxic conditions and cytokines cause new blood vessels to form (neoangiogenesis)
Cells are trapped in the joint and cannot leave
Neutrophils are present in the synovial fluid

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14
Q

What is the role of Chemokines in rheumatoid arthritis

A

Recruitment of inflammatory cells into the joint

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15
Q

What produces chemokines

A

macrophages and fibroblasts

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16
Q

What can inflammatory cytokines do

A

recruitment of inflammatory cells into a joint

Activates fibroblasts, chondrocytes and osteoclasts
promotes angiotensin

Surpasses T regs

17
Q

What is responsible for cartilage damage in rheumatoid arthritis

A

proteases (metalloproteinases and aggrecanases) which are produced by pathogenic synovial fibroblasts

18
Q

What causes bone destruction

A

mediated by osteoclasts that are activated under the influence of RNAKL which is produced by the synovium

19
Q

What are the key cytokines in rheumatoid arthritis

A

TNF alpha
IL-1
IL-2
RANk - Ligan IL-17