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MSK 2 > Rheumatoid and other inflammatory arthritis > Flashcards

Rheumatoid and other inflammatory arthritis Flashcards

1
Q

What are causes of joint inflammation?

A
  1. Infection
  2. Crystal arthritis
  3. Immune mediated
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2
Q

What are examples of infective causes of joint inflammation?

A

-Septic arthritis
-TB
Non sterile

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3
Q

What are examples of crystal arthritis?

A

-Gout
-Pseudogout
Sterile

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4
Q

What is an example of immune mediated arthritis?

A

Rheumatoid arthritis

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5
Q

What is rheumatoid arthritis?

A

-Chronic autoimmune disease
-Affects synovium

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6
Q

What are characteristics of rheumatoid arthritis?

A

-Female bias
-Age of onset 30-50s
-Systemic disease

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7
Q

What are key features of chronic arthritis?

A

-Polyarthritis
-Pain, swelling and early morning stiffness in and around joints
-May lead to joint damage and destruction

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8
Q

What are environmental risk factors for rheumatoid arthritis?

A

-Smoking
-Microbiome
-Porphyromonas gingivitis
-Poor oral health

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9
Q

What is the pattern of joint involvement in rheumatoid arthritis?

A

-Symmetrical
-Polyarthritis
-Mainly affects small joints

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10
Q

What is the difference in pain between RA and OA?

A

-RA has morning and inactivity stiffness
-OA has pain worse with activity

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11
Q

What are the types of extra articular features are present in rheumatoid arthritis?

A

-Systemic inflammation
-Organ specific

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12
Q

What are symptoms of systemic inflammation in RA?

A

-Fatigue
-Fever
-Weight loss

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13
Q

What are organ specific symptoms in RA?

A

-Subcutaneous nodules
-Lung diseases= nodules, interstitial lung disease/fibrosis, pleuritis
-Ocular inflammation
-Vasculitis
-Neuropathies
-Fetty’s syndrome= triad of splenomegaly, leukopenia, RA
-Amyloidosis

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14
Q

What are subcutaneous nodules?

A

Central area of fibrinoid necrosis surrounded by histiocytes and peripheral layer of connective tissue

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15
Q

What are subcutaneous nodules associated with?

A

-Severe disease
-Extra articular manifestations
-Rheumatoid factor

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16
Q

What are the key cellular and molecular players in RA?

A

-Autoreactive B cells
-Autoreactive T cells
-Cytokines (TNF alpha)

17
Q

What are functions of TNF alpha in RA? (3)

A

-Inflammatory cell recruitment
-Matrix metalloproteases
-Osteoclast activation

18
Q

What are key findings in bloods for RA? (4)

A

-Increased ESR
-Increased CRP
-Presence of rheumatoid factor
-Presence of anti CCP antibodies

19
Q

Why is X ray not preferred for preventative management of RA?

A

-Bone erosions only occur in established disease
-We want to treat RA early before bony manifestations occur

20
Q

What can ultrasound detect in RA?

A

-Synovial thickening
-Increased blood flow
-May detect erosions not seen in a plain X ray

21
Q

How to manage RA?

A

-Early recognition of symptoms
-Prompt initiation of treatment
-Aggressive pharmacological treatment to suppress inflammation

22
Q

What is short term treatment for RA?

A

Glucocorticoids therapy

23
Q

Why should you avoid long term use of glucocorticoids?

A

Side effects

24
Q

What is first line therapy for RA?

A

Disease modifying anti rheumatic drugs

25
Q

What is second line therapy for RA?

A

Biological therapies

26
Q

How do we measure disease activity of RA?

A

DAS28 score

27
Q

What are categories for biological therapies for RA?

A

-Targeting cytokines
-Targeting lymphocytes

28
Q

What are examples of biologics targeting cytokines?

A
  1. Inhibition of tumour necrotic factor alpha (TNF alpha)
  2. Inhibition of interleukin 6 signalling
29
Q

What are examples of biologics targeting lymphocytes?

A

-B cell depletion (rituximab)
-Blocking T cell co stimulation (abatacept)

30
Q

What are seronegative inflammatory arthritis?

A

-Psoriatic arthritis
-Reactive arthritis
-Ankylosing spondylitis
-IBD associated arthritis

31
Q

Why is it called seronegative inflammatory arthritis?

A

Don’t have autoantibodies

32
Q

Where is psoriasis maninly found?

A

Extensor surfaces

33
Q

What is the dominant pathogenic pathway of psoriatic arthritis?

A

-IL 17
-IL 23

34
Q

How does psoriatic arthritis present?

A

Symmetrical
Enthesitis

35
Q

What is reactive arthritis?

A

Sterile inflammation in joints following infection elsewhere in body

36
Q

What are common causes of reactive arthritis?

A

-Urogenital
-Gastrointestinal

MSK 2 (5 decks)

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