Flashcards in 224 RA Deck (86):
What is rheumatoid factor?
The Fc portion of IgG which is recognised by antibodies as non self
What is the cause of RA?
Persistent synovitis leading to poly arthritis and systemic inflammation. Trigger antigen unknown
What is the prevalence of RA in the UK?
At what age is the typical age of onset of RA?
30 - 50 mostly in women
Which cytokine is overexpressed in RA?
What causes the overproduction and over expression of TNF-α in RA?
Interaction between macrophages and T and B lymphocytes
What infiltrates into the synovial fluid in RA?
Inflammatory cells- incl polymorphs, lymphocytes and plasma cells
What other pyrogenic cytokine is stimulated by TNF-α?
Which cells produce a large amount of adhesion molecule?
What happens to the surface layer of lining cells in the synovium in RA?
Becomes hyperplastic and thickened
What is the cause of joint effusions in RA?
Vascular infiltration and increased permeability of vessels here
What is the mechanism of cartilage damage in RA?
Directly by cytokines and chondrocytes
Indirectly via blockage of normal nutrients to cartilage due to hyperplastic lining of synovium.
What is the mechanism of injury to the epiphyseal bone cavity in RA?
Fibroblasts grow along the vascular proliferation of synovium into the bone and cause damage
Which class of Ig is most commonly detected in investigations for RA?
What are ACPA's in RA?
Anti-citrullinated peptide antibodies --> detected in Pts with RA
Name 2 complications of RA
Which bacteria is most common in septic arthritis?
What is amyloidosis?
Disorder of protein metabolism with extracellular deposition of pathological insoluble proteins in organs and tissues
What is Boutonniere's deformity?
Fixed Flexion of PIP joint
What can swelling and subluxation of ulnar styloid in RA lead to?
Rupture of extensor tendons - causing sudden onset finger drop in ring and little finger
What is the outcome of forward migration of the fibrofatty pad underneath the prox metacarpal joint in RA?
Ulcers forming under prox MT joint
Which bacteria is most likely to cause septic arthritis?
Which 2 genes are thought to play a part in the genetic component of RA?
What are the 2 major cell types in the pannus of a rheumatic joint?
T-lymphocytes and macrophages
Name 2 complications of RA
What is amyloidosis?
Disorder of protein metabolism where amyloid proteins get deposited in tissues - β-pleated sheets which are resistant to proteolysis
What is Caplans syndrome? (occurs in RA rarely)
RA + pneumoconiosis
What type of pneumonia can occur in an RA patient?
BOOP (bronchiolitis obliterans organising pneumonia)
What are the S&S of rheumatoid vasculitis?
Nail fold infarcts
Cutaneous vasculitis and necrosis of skin
Necrosing arteritis of mesenteric vessels
What are the possible neuro complications of RA?
Peripheral sensory neuropathy
Name 3 ocular manifestations of RA
What is Felty's syndrome? (In RA)
Splenomegaly and neutropenia (increased risk of infection here)
What should be prescribed with MTX for RA?
What is the drug therapy for new RA diagnosis?
Name 2 DMARDs
Name 2 antiTNF drugs for RA
Which cytokines does TNF-α activate in RA?
IL-1, IL-6, IL-8
What do the autoantibodies target in SLE?
Which virus is associate with SLE?
What causes the rashes in SLE?
Immune complexes causing microvascular occlusions
What characteristic rashes are seen in SLE?
Malar rash (butterfly which spares nasal creases)
Which ABs are commonly found in serology of SLE?
What is the treatment for mild SLE?
What DMARD is used to treat severe SLE?
Cyclophosphamide (alkylating agent which adds alkyl to guanine base of DNA - used as chemo)
Which cells are involved with destruction of muscle fibres in polymyositis?
Cytotoxic T cells
What's the pathophysiology of dermatomyositis?
Auto antibodies causing activation of the complement system - damages muscle capillaries
What are Gottron's papules a sign of?
Where is the macular erythematous rash most commonly found on a pt with dermatomyositis?
Face and chest
What investigation is performed to confirm a diagnosis of dermatomyositis?
What are the possible serious complications which can arise in a pt with dermatomyositis?
Aspiration due to swallowing difficulty
Lung fibrosis due to chest wall weakness
Which AB is involved in limited systemic sclerosis?
Which antibody is seen in diffuse systemic sclerosis?
What are the clinical features of systemic sclerosis?
Esophageal and GIT dysmotility
What are the possible complications of diffuse systemic sclerosis?
Pulmonary HTN leading to L sided HF
Renal crisis leading to accelerated malignant HTN
Name 2 drugs which can be used to treat systemic sclerosis and scleroderma
What is the pathophysiology of Sjögren syndrome?
Lymphocytic infiltration to exocrine organs
Which antibodies are present in Sjögren syndrome?
Anti-Ro and anti-La
(Also RF and ANA)
What are the S&S of Sjögren syndrome?
Dry eyes and mouth
Salivary gland enlargement
Which condition is linked to giant cell arteritis?
Name one complication of GCA
Blindness due to arteritis of ophthalmic artery
Name 2 S&S of GCA
Localised HA (scalp tenderness)
Temporal artery enlargement and tenderness
+ constitutional symptoms
What is vasculitis?
Inflammation within the walls of vessels causing impairment to blood flow and damage to vessel integrity - leads to haemorrhage and infarction of organs
What investigation is required in GCA?
Temporal artery biopsy
Is GCA more common in men or women?
What is the immediate treatment of GCA?
High dose steroids within 24 hours
What is Takayasu's arteritis?
Granulomatous inflammation of aortic arch and branches
Name 2 S&S of Takayasu's arteritis
Claudication/pulslessness of upper limbs (+/- lower limbs)
HTN due to renal artery stenosis
Name 2 investigations to diagnose Takayasu arteritis
What is the treatment of Takayasu's arteritis
High dose steroids
What is the pathophysiology of granulomatous polyangiitis?
Ig's against ANCAs, especially PR3 which causes increased neutrophil of activation and granuloma formation
Which structures does granulomatous polyangiitis normally affect?
Midline - eyes, nose, trachea, lungs
Name 2 ENT S&S of granulomatous polyangiitis
Name 2 pulmonary S&S of granulomatous polyangiitis
Name 2 renal S&S of granulomatous polyangiitis
What is the treatment of mild/moderate granulomatous polyangiitis?
MTX/azothioprine + steroids
Which drug is used for the treatment of severe granulomatous polyangiitis?
What is polyarteritis nodosa?
Necrotising inflammationof small/medium sized arteries causing lesions in bifurcation which can lead to micro aneurysms, haemorrhage and thrombosis
Which sign is diagnostic of polyarteritis nodosa?
Rosary sign in arteries
Which investigations are useful to diagnose polyarteritis nodosa?
Inflammatory markers in blood
What is the treatment of polyarteritis nodosa?
Steroids and Immunosuppression
Which virus is a trigger in 30% of pts with polyarteritis nodosa?
What is Churg-Strauss syndrome?
Rare complication of asthma (moderate yo severe) leading to vascular necrosis which starts in the lungs
How does Churg-Strauss syndrome typically present?
Which markers are present in serology in Churg-Strauss syndrome?
What are the 3 stages of Churg-Strauss syndrome?
1. Allergic rhinitis and asthma
2. Eosinic infiltration - cough, pneumonia
3. Widespread i.e. Peripheral neuropathy, renal, arthralgia, purpurin, diarrhoea, GIT bleeding, myocarditis/pericarditis