W10 - RHEUM I: R.Arth., RA Therapeutics

Question 1

Definition of RA

Answer 1

• chronic, symmetric
• polyarticular. inflammation of joints: mainly small joints of hands & feet
• SYNOVITIS = inflamm cell infiltration, synoviocyte prolif., and neoangiogen.
• neutrophils within synovial fluid
  = BONE AND CARTILAGE DESTRUCTION

Question 2

Aetiology of RA: AuImm; Env. Factors;

Answer 2

1. Autoimmunity = auAb = Rheumatoid Factor, anti-citrullinated protein Ab associations
   * Ab attack type II collagen
   * Ab attack glucose phosphate isomerase
2. GENETIC FACTORS
3. ENVIRONMENT FACTORS
   * smoking / bronchial stress
   * Infectious = viruses, e. coli, peridontal disease
   = rpt insults to genetic susceptible = formation of AuAb

Question 3

Seropositive RA Vs Seroneg RA

Answer 3

sero+ RA

• RheumFactor
• ACPA = Dx by anti-CCP = worse prognosis

Question 4

Pathogenesis of RA

Answer 4

1. SYNOVITIS
   neovascularisation = support of hyperplastic synovium
   villous hyperplasia
   immune infiltration
   fibroblast proliferaation (activated by inflamm. cytokins)
2. CARTILAGE & BONE DESTRUCTION
   = joint space narrowing and erosion
   facilitated by distinct proteases and aggrecanases

as well as osteoclast activity induced by the RA synovium (RANKL)

Question 5

Systemic Consequences of RA pathogenesis

Answer 5

VASCULITIS; noduls, amyloidosis = 2º to uncontrolled chronic inflamm

CARDIOVASC. DISEASE

FATIGUE & COGNITIVE DECLINE (2º fibromyalgia)

LIVER
LUNG
muscle: sarcopenia

Question 6

Rheumatology: Principles of Tx (medical)

Answer 6

consider pyramid of treatment

1. NSAIDs
2. DMARDs
   > METHOTREXATE
   > SULFASALAZINE
3. BIOLOGICS: faster than DMARDs, well tolerated
   > ETANRCEPT
   > antiTNFa
   + enhanced response w/ METHOTREXATE

!infection, ?malignancy, COST

4. CORTICOSTEROIDS: short term benefit

Question 7

What is are the functions of synovium

Answer 7

• lubriction of cart., synovial fluid vol. control
• maintenance of tissue surface
• nutrition of chondrocytes

Question 8

Takehome message of RA Rx

Answer 8

Early and aggressive intervention = optimal outcomes = prevent inflamm and disability

Question 9

Treat to Treat in RA mgmt

Answer 9

Tight control, tight aims = remission, functional achievement

• tight review
• adaptations to. dosages in response to Tx response

Question 10

Diagnosing RA & Follow-up Picture

Answer 10

Bloods: RF, antiCCPAb

Hand and foot XR

> Glucocorticoids
DMARD tx

FOLLOW UP
Arthritis clinic (nurses)
- monthly, monitor via DAS28
- monitor blood tests

MDT input