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Flashcards in 224 RA Deck (86):
0

What is rheumatoid factor?

The Fc portion of IgG which is recognised by antibodies as non self

1

What is the cause of RA?

Persistent synovitis leading to poly arthritis and systemic inflammation. Trigger antigen unknown

2

What is the prevalence of RA in the UK?

0.5-1%

3

At what age is the typical age of onset of RA?

30 - 50 mostly in women

4

Which cytokine is overexpressed in RA?

TNF-α

5

What causes the overproduction and over expression of TNF-α in RA?

Interaction between macrophages and T and B lymphocytes

6

What infiltrates into the synovial fluid in RA?

Inflammatory cells- incl polymorphs, lymphocytes and plasma cells

7

What other pyrogenic cytokine is stimulated by TNF-α?

IL-6

8

Which cells produce a large amount of adhesion molecule?

Synovial fibroblasts

9

What happens to the surface layer of lining cells in the synovium in RA?

Becomes hyperplastic and thickened

10

What is the cause of joint effusions in RA?

Vascular infiltration and increased permeability of vessels here

11

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.

12

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

13

Which class of Ig is most commonly detected in investigations for RA?

IgM

14

What are ACPA's in RA?

Anti-citrullinated peptide antibodies --> detected in Pts with RA

15

Name 2 complications of RA

Septic arthritis
Amyloidosis

16

Which bacteria is most common in septic arthritis?

Staph aureus

17

What is amyloidosis?

Disorder of protein metabolism with extracellular deposition of pathological insoluble proteins in organs and tissues

18

What is Boutonniere's deformity?

Fixed Flexion of PIP joint

19

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

20

What is the outcome of forward migration of the fibrofatty pad underneath the prox metacarpal joint in RA?

Ulcers forming under prox MT joint

21

Which bacteria is most likely to cause septic arthritis?

Staph A

22

Which 2 genes are thought to play a part in the genetic component of RA?

HLA-DR4
PTPN22

23

What are the 2 major cell types in the pannus of a rheumatic joint?

T-lymphocytes and macrophages

24

Name 2 complications of RA

Septic arthritis
Amyloidosis

25

What is amyloidosis?

Disorder of protein metabolism where amyloid proteins get deposited in tissues - β-pleated sheets which are resistant to proteolysis

26

What is Caplans syndrome? (occurs in RA rarely)

RA + pneumoconiosis

27

What type of pneumonia can occur in an RA patient?

BOOP (bronchiolitis obliterans organising pneumonia)

28

What are the S&S of rheumatoid vasculitis?
5 listed

Nail fold infarcts
Cutaneous vasculitis and necrosis of skin
Mononeuritis multiplex
Necrosing arteritis of mesenteric vessels
Leg ulcers

29

What are the possible neuro complications of RA?
4 listed

Carpal tunnel
Tarsal tunnel
Peripheral sensory neuropathy
Cord compression

30

Name 3 ocular manifestations of RA

Sicca syndrome
Scleritis/episcleritis
Scleromalacia perforans

31

What is Felty's syndrome? (In RA)

Splenomegaly and neutropenia (increased risk of infection here)

32

What should be prescribed with MTX for RA?

Folic acid

33

What is the drug therapy for new RA diagnosis?

Analgesia
NSAID's
Corticosteroids
1 DMARD

34

Name 2 DMARDs
(4 listed)

MTX
Sulphasalazine
Leflunomide
Hydroxychloroquine

35

Name 2 antiTNF drugs for RA

Infliximab
Adalimumab
Certolimab
Rituximab

36

Which cytokines does TNF-α activate in RA?

IL-1, IL-6, IL-8

37

What do the autoantibodies target in SLE?

Nuclear antigens

38

Which virus is associate with SLE?

Epstein Barr

39

What causes the rashes in SLE?

Immune complexes causing microvascular occlusions

40

What characteristic rashes are seen in SLE?

Malar rash (butterfly which spares nasal creases)
Discoid rash
Photosensitivity rash

41

Which ABs are commonly found in serology of SLE?
4 listed

ANA (100%)
dsDNA (50%)
antiSM (15%)
anti-Ro/anti-La (20%)

42

What is the treatment for mild SLE?

NSAIDs
Hydroxychloroquine
Steroids

43

What DMARD is used to treat severe SLE?

Cyclophosphamide (alkylating agent which adds alkyl to guanine base of DNA - used as chemo)

44

Which cells are involved with destruction of muscle fibres in polymyositis?

Cytotoxic T cells

45

What's the pathophysiology of dermatomyositis?

Auto antibodies causing activation of the complement system - damages muscle capillaries

46

What are Gottron's papules a sign of?

Dermatomyositis

47

Where is the macular erythematous rash most commonly found on a pt with dermatomyositis?

Face and chest

48

What investigation is performed to confirm a diagnosis of dermatomyositis?

Muscle Bx

49

What are the possible serious complications which can arise in a pt with dermatomyositis?
2 listed

Aspiration due to swallowing difficulty
Lung fibrosis due to chest wall weakness

50

Which AB is involved in limited systemic sclerosis?

Anti-centromere AB

51

Which antibody is seen in diffuse systemic sclerosis?

Scl-l70 AB

52

What are the clinical features of systemic sclerosis?
(CREST)

Calcinosis
Raynauds
Esophageal and GIT dysmotility
Sclerodactyly
Telangectasia

53

What are the possible complications of diffuse systemic sclerosis?
(2 listed)

Pulmonary HTN leading to L sided HF
Renal crisis leading to accelerated malignant HTN

54

Name 2 drugs which can be used to treat systemic sclerosis and scleroderma

Mycophenolate mofetil
Cyclophosphamide

55

What is the pathophysiology of Sjögren syndrome?

Lymphocytic infiltration to exocrine organs

56

Which antibodies are present in Sjögren syndrome?

Anti-Ro and anti-La
(Also RF and ANA)

57

What are the S&S of Sjögren syndrome?
3 listed

Dry eyes and mouth
Salivary gland enlargement
Purpura

58

Which condition is linked to giant cell arteritis?

Polymyalgia rheumatica

59

Name one complication of GCA

Blindness due to arteritis of ophthalmic artery

60

Name 2 S&S of GCA
(4 listed)

Jaw claudication
Localised HA (scalp tenderness)
Temporal artery enlargement and tenderness
+ constitutional symptoms

61

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

62

What investigation is required in GCA?

Temporal artery biopsy

63

Is GCA more common in men or women?

Women

64

What is the immediate treatment of GCA?

High dose steroids within 24 hours

65

What is Takayasu's arteritis?

Granulomatous inflammation of aortic arch and branches

66

Name 2 S&S of Takayasu's arteritis
(4 listed)

Constitutional
Claudication/pulslessness of upper limbs (+/- lower limbs)
HTN due to renal artery stenosis
Neuro symptoms

67

Name 2 investigations to diagnose Takayasu arteritis

Arteriography
Echo

68

What is the treatment of Takayasu's arteritis

High dose steroids

69

What is the pathophysiology of granulomatous polyangiitis?

Ig's against ANCAs, especially PR3 which causes increased neutrophil of activation and granuloma formation

70

Which structures does granulomatous polyangiitis normally affect?

Midline - eyes, nose, trachea, lungs
(+ kidneys)

71

Name 2 ENT S&S of granulomatous polyangiitis
(3 listed)

Saddle nose
Epistaxis
Sinusitis

72

Name 2 pulmonary S&S of granulomatous polyangiitis
(3 listed)

Pulmonary infiltrates
Cough
Haemoptysis

73

Name 2 renal S&S of granulomatous polyangiitis
(3 listed)

Microscopic haematuria
Casts
Renal failure

74

What is the treatment of mild/moderate granulomatous polyangiitis?

MTX/azothioprine + steroids

75

Which drug is used for the treatment of severe granulomatous polyangiitis?

Cyclophosphamide

76

What is polyarteritis nodosa?

Necrotising inflammationof small/medium sized arteries causing lesions in bifurcation which can lead to micro aneurysms, haemorrhage and thrombosis

77

Which sign is diagnostic of polyarteritis nodosa?

Rosary sign in arteries

78

Which investigations are useful to diagnose polyarteritis nodosa?

Inflammatory markers in blood
Artery biopsy

79

What is the treatment of polyarteritis nodosa?

Steroids and Immunosuppression

80

Which virus is a trigger in 30% of pts with polyarteritis nodosa?

HepB

81

What is Churg-Strauss syndrome?

Rare complication of asthma (moderate yo severe) leading to vascular necrosis which starts in the lungs

82

How does Churg-Strauss syndrome typically present?

Hypergammaglobinaemia

83

Which markers are present in serology in Churg-Strauss syndrome?

IgE
RF
ANCA

84

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

85

What can be seen on CXR in a person with Churg-Strauss syndrome?

Bilateral, peripheral patchy parenchymal opacities