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Flashcards in BL- RA Deck (45):
1

secondary causes of hyperuricemia in normal uric acid metabolism

a

2

RHEUMATOID ARTHRITIS
Articular manifestations
Joint distribution 1

Predominantly peripheral synovial joints in a symmetric pattern, particularly the small joints of the hands and feet, although medium and large joints are also involved.

DIP often spared.

3

Rheumatoid arthritis (RA) is a systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a peripheral, symmetric, inflammatory synovitis often leading to:

cartilage and bone destruction and joint deformities

4

RHEUMATOID ARTHRITIS
Articular manifestations
Joint distribution 2

Cervical spine also commonly involved (usually C1-2)

Other synovial joints may be involved including the cricoarytenoid, ossicles of inner ear, and temporomandibular joint.

5

Rheumatoid arthritis (RA) is a ______________ disorder of unknown etiology that results predominantly in a peripheral, symmetric, inflammatory synovitis often leading to cartilage and bone destruction and joint deformities

systemic, inflammatory, autoimmune

6

Joint spared in RA?

DIPs

7

RHEUMATOID ARTHRITIS
Articular manifestations
Symptoms

Morning stiffness, soft tissue swelling around joints, and pain.

Deformities and loss of function possible.

8

Rheumatoid arthritis (RA) is a systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a __________ often leading to cartilage and bone destruction and joint deformities

peripheral, symmetric, inflammatory synovitis

9

RHEUMATOID ARTHRITIS
Articular manifestations
Signs

Joint warmth and swelling

Tenderness to palpation with limitation of motion.

Possible deformities may be present.

10

Serologic findings RA
Rheumatoid factor (RF) is present in ______.

85%

11

Serologic findings RA
_______proteins often elevated.

ESR or C-reactive

12

Anemia and ______are frequently found in RA

hypergammaglobulinemia

13

Anti-cyclic citrullinated peptide (CCP) antibodies present in ______: Anti-CCP antibodies are highly specific (specificity > 90%) for RA.

70%

14

______ and hypergammaglobulinemia are frequently found in RA

Anemia

15

Anti-cyclic citrullinated peptide (CCP) antibodies present in 70%: Anti-CCP antibodies are highly_______

specific (specificity > 90%) for RA.

16

Synovial fluid analysis RA

Inflammatory (>2000 WBC/microliter) with predominantly neutrophils.

Complement and glucose levels usually low.

17

Radiographic findings RA

Soft tissue swelling.

Juxta-articular osteopenia.

Symmetric loss of joint space.

Erosions in marginal distribution.

18

Rheumatoid nodules

Present in 20-25%, associated with presence of serum RF.

Location: extensor surfaces and tendon sheaths.

May be present in a variety of internal organs, particularly lung.

19

Rheumatoid arthritis is a common disease with characteristic articular and extra-articular clinical manifestations, and helpful:

X-ray and laboratory findings.

20

This is a polygenic disease with different sets of genes being involved in different population groups.
Specific _________ appear to predispose both to acquiring the disease and to developing greater degrees of severity of joint tissue destruction.

HLA-DR molecules

21

The pathology is an inflammatory synovitis with fibroblasts, macrophages, mast cells, T cells, B cells, plasma cells and dendritic cells in the synovium all involved, as well as ___________

chondrocytes in the articular cartilage

22

The pathology is an inflammatory synovitis with fibroblasts, macrophages, mast cells, T cells, B cells, plasma cells and dendritic cells in the ______ all involved, as well as chondrocytes in the articular cartilage

synovium

23

The pathology is an inflammatory synovitis with _______ cells in the synovium all involved, as well as chondrocytes in the articular cartilage

fibroblasts
macrophages
mast cells
T cells
B cells
plasma cells
dendritic

24

CD4+ T cells in the synovium may be important in initiation and maintenance of the disease process through recognition of arthritogenic peptides. B cells also are important both through production of _______ and sustaining T cell function.

autoantibodies

25

The destruction of articular cartilage and marginal bone is carried out by neutral proteinases released by proliferating fibroblasts in the synovium, called pannus, and by chondrocytes in the articular cartilage under the influence of IL-1 and TNF-alpha primarily derived from synovial _____.

macrophages

26

CD4+ T cells in the synovium may be important in the disease process through recognition of _______. B cells also are important both through production of autoantibodies and sustaining T cell function.

arthritogenic peptides

27

The destruction of articular cartilage and marginal bone is carried out by neutral proteinases released by proliferating fibroblasts in the synovium, called pannus, and by chondrocytes in the articular cartilage under the influence of _______ primarily derived from synovial macs

IL-1 and TNF-alpha

28

______cells in the synovium may be important in initiation and maintenance of the disease process through recognition of arthritogenic peptides. B cells also are important both through production of autoantibodies and sustaining T cell function.

CD4+ T

29

The destruction of articular cartilage and marginal bone is carried out by neutral proteinases released by proliferating _______, called pannus, and by chondrocytes in the articular cartilage under the influence of IL-1 and TNF-alpha primarily derived from synovial macs. (RA)

fibroblasts in the synovium

30

IL-1, TNF-alpha, and IL-17 also play a role in osteoclast formation. Neutrophils in the synovial fluid also may contribute to_______. (RA)

tissue destruction

31

Synovial macrophages stimulated by T cells, or both macrophages and fibroblasts in chronic rheumatoid synovitis may function in an autonomous and _______. (RA)

self-perpetuating fashion

32

IL-1, TNF-alpha, and IL-17 also play a role in osteoclast formation. _______also may contribute to tissue destruction. (RA)

Neutrophils in the synovial fluid

33

________, or both macrophages and fibroblasts in chronic rheumatoid synovitis may function in an autonomous and self-perpetuating fashion. (RA)

Synovial macrophages stimulated by T cells

34

_______also play a role in osteoclast formation. Neutrophils in the synovial fluid also may contribute to tissue destruction. (RA)

IL-1, TNF-alpha, and IL-17

35

Treatment as Related to Pathophysiology (RA)

Anti-inflammatory/analgesic drugs

relieve patient symptoms, but these do not prevent tissue destruction.

The mechanisms of action include inhibition of production of inflammatory mediators.

36

Treatment as Related to Pathophysiology (RA)

Disease-modifying anti-rheumatic drugs (DMARDs)

primarily inhibit various macrophage and lymphocyte functions.

Newer therapeutic agents include biologic agents that inhibit the effects of cytokines, particularly IL-1 , TNFalpha and IL-6 (tocilizumab);

inhibit a T cell costimulator molecule and modulate T cell activation or deplete B cells (rituximab).

37

Treatment as Related to Pathophysiology (RA)

"other" options

PT
Surgery

38

primarily inhibit various macrophage and lymphocyte functions.

Newer therapeutic agents include biologic agents that inhibit the effects of cytokines, particularly IL-1 , TNFalpha and IL-6 (tocilizumab);

inhibit a T cell costimulator molecule and modulate T cell activation or deplete B cells (rituximab).

DMARDs

39

_____________are instituted early after diagnosis in an effort to prevent tissue destruction. These medications include hydroxychloroquine, sulfasalazine, leflunomide, or methotrexate.

Disease-modifying anti-rheumatic drugs (DMARDs)

40

Rheumatoid factors (RF) are immunoglobulins that recognize epitopes present within the _____.

Fc portion of IgG

lead to complement activation via the classical pathway, producing inflammatory consequences

41

Lumbosacral spine - both sacroiliac joint spaces are completely obliterated. There is also obliteration of the posterior elements in the distal lumbar area and bridging or "bambooing of the spine". Chest x-ray - "squaring-off of the mid-portion of the thoracic vertebrae but no significant syndesmophyte formation.

Diagnosis? (it's not RA)

Ankylosing spondylitis

42

The enthesis is the_______between tendon or ligament and bone.

connective tissue
Related to AS

43

What percent of AS has peripheral arthritis?

25%

100% in RA has peripheral involvement

44

Spine involvement in RA?

C spine
C1/C2

very severe poorly treated RA

45

spondyloarthropathy diseases that are bilateral?

AS and colitis