Rheumatoid Arthritis

Question 1

what is rheumatoid arthritis?

Answer 1

• chronic autoimmune connective tissue disease (joints & elsewhere)
• causing deformed synovial joints
• not restricted to joints as this disease progresses it affects connective tissue (pericarditis, integument)

Question 2

what drives this disease

Answer 2

inflammation and autoimmunity drive this disease

Question 3

etiology of rheumatoid arthritis?

Answer 3

Complex trait:
-genetic predisposition (HLA gene-HLA protein sits on surface of cell membrane, defense cell recognizes cells as “normal) (abnormalties cause the defense cells to destroy normal cells NOTE: MHC is part of chromosome where that gene is located)

-environmental trigger (usually viral, sometimes bacterial) mainly Epstien Barr Virus
(have the virus then immunity changes and now it targets joints & connective tissue)

Question 4

where does rheumatoid arthritis initially starts where?

Answer 4

in the non-weight bearing joints (fingers, toes, wrists)

Question 5

what is the patho of rheumatoid arthritis?

Answer 5

• T helper cells activated
• release of cytokines (eg. TNF & IL-1)
• altered T cell response, targets synovial membrane causing inflammatory joint damage (this is autoimmunity)
• altered B cells then antibodies produce (rheumatoid factors(RF)) with then targets tissues (inflm damage & autoimmunity)
• antibodies rheumatoid factor forms immune complex and then deposits in synovial membrane causing inflammation (TYPE 3 HYPERSENSITIVITY)
• repeated inflammation causing deformity
• Pannus (contains vascular & granulation tissue) pannus= space occupying lesion, Pannus:
• contains Inflammatory cells
• release destructive enzymes (damage to cartilage)
• decrease in joint mobility (because pannus is taking up space)

Question 6

what is the space occupying lesion in rheumatoid arthritis called?

Answer 6

Pannus

Question 7

characteristics of the pannus

Answer 7

Pannus (contains vascular & granulation tissue) pannus= space occupying lesion, Pannus:

• contains Inflammatory cells
• release destructive enzymes (damage to cartilage)
• decrease in joint mobility (because pannus is taking up space)

Question 8

what are some of the deformative looks of rheumatoid arthritis?

Answer 8

• swarm neck
• ulnar drift/shift/deviation
• subcutaneous nodules (swelling in joints)
• there is alteration in the alignment of ligaments causing deformities

Question 9

what are the mnfts of rheumatoid arthritis?

Answer 9

• extra articular(systemic) & aritcular (in joints)
• subtle onset causing malaise, fatigue & aches
• increasing fatigue
• stiffness after inactivity (if you dont use joints stiffens this is reversible though opposed to fused joints which is irreversible)
• AM joint pain
• non articular (these are widespread, in heart, blood vessels, skin, lungs, eyes) (autoimmunity targeting connective tissue, heart contains connective tissue, targets CT in heart causes inflm in other tissues such as muscle tissue

Question 10

the mnfts of rheumatoid arthritis can be _____ & ________

Answer 10

extra atricular (systemic) & articular (joints)

Question 11

Diagnosing rheumatoid arthritis?

Answer 11

• hx, px
• x-ray (but not going to be revealing, particularly in early stage)
• Labs (CBC, CRP, ESR) which will give indication of inflammation
• rheumatoid factor (20% of pts will be negative for rheumatoid factor)
• ANA (anti-nuclear antibodies)
• anti -CCP(cyclic citrilline peptide)(citrilline is type of peptide & peptide is an amino acid) (this test is far more SPECIFIC than rheumatoid factor)

Question 12

treatment of rheumatoid arthritis?

Answer 12

• limit progression
• pain management (eg. meloxicam-non steroidal anti-inflm or naproxin (naprocyn) also a non steroidal(anti-inflm)
• Immunomodulator: start with plaquenil

Question 13

treatment of rheumatoid arthritis?

Answer 13

• limit progression
• pain management (eg. meloxicam-non steroidal anti-inflm or naproxin (naprocyn) also a non steroidal(anti-inflm)
• Immunomodulator: start with plaquenil (will need eye exam q6-12 months, assessed by ophthalmologist) (not a typical drug, this drug also used to treat malaria) (2 properties used here 1-immunomodulating or immunoregulating 2-anti-inflammatory (plaquenil depsotis in eye & can affect eye) (some pts will not be able to tolerate side effects of plaquenil)
• usually multi-therapy eg. Sulfasalazine & methotrexate (BOTH immunomodulators) (CBC, liver enzymes & creatinine monthly) (because these drugs are hepatotoxic) (in liver look at enzymes if there is damage to cells will release content and enzymes will be elevated) (see how severly affecting erythrocyte production is methotrexate which is an anti-folate) (drugs may cause damage to kidneys, and then not able to excrete creatinine)
• minocycline (abx, if used for rheumatoid arthritis, not being used for antibiotic properties (rarely prescribed) immunomodulator action (side effect is hyperpigmentation-look dirty)