L7:pathophysiology of joint disease

Question 1

RF=

Answer 1

rheumatoid factor

Question 2

CCP=

Answer 2

cyclic citrullinated peptide

Question 3

joints affected by RA

Answer 3

MCPs
MTPs
wrists

Question 4

5 key features of RA

Answer 4

• Chronic
• symmetrical
• inflammatory
• deformity
• polyarthritis

Question 5

primary site of pathology in RA

Answer 5

synovium

Question 6

synovitis=

Answer 6

inflammation of the synovial cells

Question 7

first cell to be triggered in RA

Answer 7

T-cells

Question 8

what do triggered T cells in RA do

Answer 8

stimulate macrophage, fibroblast and B-cell activity

Question 9

most important cytokines in RA

Answer 9

TNF-alpha

IL-1

Question 10

what do fibroblasts produce

Answer 10

some inhibitory cytokines

Question 11

after being activated by T-cells what do B-cells do

Answer 11

produce antibodies RF and Anti-CCP

Question 12

what do RF and anti-CCP cause

Answer 12

synovial cell proliferation, synovitis and potential tissue damage

Question 13

what do -mab drugs block

Answer 13

cytokines (especially TNF-alpha)

Question 14

what effect does TNF-alpha have on hepatocytes

Answer 14

stimulates C-reative protein (CRP)

Question 15

what does prolonged inflammation lead to

Answer 15

bone damage

Question 16

5 consequences of chronic systemic inflammation

Answer 16

1. early IHD
2. hypercholesterolaemia
3. osteoporosis
4. insulin resistance
5. sacropenia

Question 17

why is there increased CV mortality with RA

Answer 17

accelerated atherosclerosis

Question 18

what inflammatory markers can predict erosion

Answer 18

ESR

CRP

Question 19

HAQ=

Answer 19

health questionnaire used to assess function

Question 20

most common joint disorder=

Answer 20

osteoarthritis

Question 21

joints affected in osteoarthritis (4)

Answer 21

DIP
PIP
CMC
MTPI

Question 22

when do you get symptoms with osteoarthritis

Answer 22

with activity

Question 23

6 risk factors for Osteoarthritis

Answer 23

age
female sex
genetics 
obesity 
oestrogen deficiency 
BMD

Question 24

central core treatments for osteoarthritis (3)

Answer 24

• education and information
• exercise and strengthening
• weight loss

Question 25

what builds up over time with recurrent gout

Answer 25

soft tissue deposits of uric acid called tofi

Question 26

why aren’t women as susceptible to gout

Answer 26

oestrogen stimulates the kidneys to excrete more uric acid

Question 27

3 common comorbidities in gout

Answer 27

renal impairment
coronary heart disease
metabolic syndrome

Question 28

what diet is bad for gout

Answer 28

high-purine diet

Question 29

uric acid formation uses which pathway

Answer 29

purine metabolic pathway

Question 30

key enzymes in purine metabolic pathway

Answer 30

xanthine oxidase

Question 31

2 medications targeting xanthine oxidase

Answer 31

allopurinol, febuxostat

Question 32

2 ways uric acid can accumulate

Answer 32

over production of urate

underexcretion of urate

Question 33

4 triggers for gout attacks

Answer 33

• direct trauma
• medications
• rapid weight loss
• dehydration/ acidosis

Question 34

podagra=

Answer 34

gout affecting big toe

Question 35

how do gout attacks often start

Answer 35

rapidly over night or in the early morning

Question 36

what joint are 50% of gout attacks in

Answer 36

metatarsophalangeal joint of first toe

Question 37

what is present in joints in gout

Answer 37

monosodium urate crystals

Question 38

what do men with gout have a large increase risk of

Answer 38

kidney stones

Question 39

attacks of gout caused by

Answer 39

deposition of urate crystals in joints resulting in inflammation

Question 40

what allows gout diagnosis (2)

Answer 40

crystals in joints or tophus aspirate

Question 41

most common bacteria causes septic arthritis

Answer 41

Staphylococcus aureus

Question 42

antibiotic regime for septic arthritis

Answer 42

IV antibiotics for 2 weeks then 4 weeks oral antibiotics on return home