Early Pathophysiology Of RA

Question 1

What causes RA

Answer 1

Unknown

Question 2

Possible RA triggers

Answer 2

Infection
Smoking
Obesity
Stress
Female hormones
Pregnancy

Question 3

Difference between seropositive and seronegative RA

Answer 3

seropositive has anti citrullinated protein antibodies
Seronegative has no ACPAs
Same clinical presentation

Question 4

Is seropositive or seronegative RA harder to control and which is more common

Answer 4

Seropositive for both

Question 5

Are smoking, bacterial infections, HLA-DRB1, and PTPN22 risk factors for seropositive or seronegative RA

Answer 5

Seropositive

Question 6

Are cytomegalovirus, EBV, IRF5, and C type lectins risk factors for seropositive or seronegative RA

Answer 6

Seronegative

Question 7

Does seropositive or seronegative have higher disease activity, more CV complications, more joint destruction, and higher death rate

Answer 7

Seropositive

Question 8

What process by neutrophils is involved in RA

Answer 8

NETosis

Question 9

NETosis

Answer 9

Neutrophils release NETs - lattice of NET fibres containing enzymes, anti microbial peptides, and ion chelations to kill microorganisms

Question 10

Suicidal NETosis

Answer 10

NETosis where the cell is ruptured and killed to release the NET

Question 11

Which enzyme citrullinates arginine to citroline

Answer 11

Protein arginine deaminase 4 PAD4

Question 12

What can cause neutrophils to undergo NETosis in RA when no bacteria are present

Answer 12

Autoantibodies

Question 13

Rheumatoid factor

Answer 13

IgM to Fc portion of IgG

Question 14

What processes require PAD4 mediated citrullination of histones

Answer 14

NET formation
Bacterial clearance

Question 15

Carbamylation

Answer 15

Converts lysine into homocitrullines by reaction with cyanate

Question 16

How does inflammation and damage from smoking affect anti-CarP antibodies

Answer 16

Incr production of cyanates

Question 17

Which 3 autoantibodies make up triple positivity and is almost exclusive in RA

Answer 17

Rheumatoid factor
Anti citrullinated protein antibodies ACPA
Anti carbamylated protein antibodies A-CarP

Question 18

Which 2 chemical processes are involved in RA progression

Answer 18

Citrullination
Carbamylation

Question 19

What can number of anti modified protein antibodies AMPAs in a RA pts serum predict

Answer 19

Severity of disease
Chance of relapse

Question 20

Anchor drug treatment for all RA pts

Answer 20

Methotrexate

Question 21

Is a higher methotrexate starting dose needed to get remission in a seronegative or seropositive RA pt

Answer 21

Seropositive

Question 22

Seronegative RA treatment

Answer 22

Methotrexate

Question 23

What causes inflammation in RA

Answer 23

activation of T cells, B cells, and macrophages which release cytokines causing joint damage

Question 24

Effects of inflammatory cytokines leaking into the bloodstream in RA pts

Answer 24

Systemic inflammation
Anaemia
Thrombocytes is
Fatigue
Osteoporosis
Acute phase response

Question 25

Systemic RA signs and symptoms

Answer 25

Fever Weight loss Muscle fatigue

Question 26

Haematological and vascular RA signs and symptoms

Answer 26

Anaemia Thrombocytosis Eosinophilia Digital arthritis Ulcers Pyoderma gangrenosum

Question 27

Muscoluskeletal RA signs and symptoms

Answer 27

Muscle wasting TenoSynovitis Bursitis Osteoporosis

Question 28

Ocular RA signs and symptoms

Answer 28

Episcleritis / scleritis Scleromalacia Keratoconjunctivitis sicca

Question 29

RA cardiac signs and symptoms

Answer 29

Pericarditis Myocarditis Endocarditis Conduction defects Coronary vasculitis Granulomatous aortitis

Question 30

What type of anaemia is anaemia of chronic disease

Answer 30

Normochromic and Normocytic Progress to Hypochromic then Microcytic

Question 31

Rheumatoid nodules

Answer 31

Firm non tender subcutaneous lumps usually forming around joints subjected to pressure/trauma