Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBBS II MSS > L04 - Introduction to inflammatory joint disorders > Flashcards

L04 - Introduction to inflammatory joint disorders Flashcards

1
Q

Define Rheumatoid arthritis?

A

Rheumatoid arthritis (RA)= systemic, chronic inflammatory autoimmune disease principally attacking the joints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the epidemiology of RA?

A

relatively common condition

prevalence 1%;

3 - 5x women > men

Peak @ 20-40 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

pathogenesis of RA?

A

susceptibility genes + trigger CD4+ T cells by arthritogenic agent (e.g. microbial infection or self-antigen CCP)

> > T and B cell responses to self-antigens

> > Proliferation of Fibroblasts, Chondrocytes, Synovial cells

> > Release of enzymes collagenase, Stromelysin**, elastase … etc

> > Pannus formation and destruction of bone, cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the AutoAb in RA

A

cytokine-mediated inflammation (CD4+ T cell)

AutoAb vs cyclic citrullinated peptides (CCPs)
+
AutoAb vs citrullinated fibrinogen, type II collagen, Vimentin***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What genetic factors predispose RA?

A

HLA- DRB1

PTPN-22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the typical manifestation of RA?

A

symmetric arthritis - Polyarticular

small joints of the hands and feet

ankles, knees, wrists, elbows, and shoulders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which joints in the hands are affected by RA?

A

proximal interphalangeal and
metacarpophalangeal joints are affected

distal interphalangeal joints are spared.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which axial joints are affected in RA?

A

limited to the upper cervical spine***

hip joint involvement is extremely uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define “Pannus formation” in RA.

A

Pannus = chronic papillary synovitis: edematous, villous

+ inflammatory cells, granulation tissue, fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

5 histological features of Rheumatoid synovium?

A
  • synovial hyperplasia
  • dense perivascular inflammatory cell infiltrates
  • increased vascularity
  • aggregates of fibrin on synovium
  • periarticular bone erosion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does RA lead to ankylosis?

A

Juxta-articular bone erosion by pannus
> pannus fills the joint space
> fibrosis and ossification
> ankylosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the radiological hallmarks of RA?

A

joint effusions*

juxtaarticular osteopenia/ erosions*

narrowing of the joint space

loss of articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

deformations of the digits seen in RA?

A

1) Radial deviation of the wrist
2) Ulnar deviation of fingers
3) swan-neck deformity of fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 extra-articular features of RA?

A
  • Rheumatoid nodules
  • Lung fibrosis
  • Vasculitis
  • Amyloidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some drugs for RA?

A

Symptom-modifying anti-rheumatic drugs
• Non steroidal antiinflammatory drugs (NSAIDs)
• Cycloxygenase 2 (COX II) inhibitor

Disease-modifying anti-rheumatic drugs (DMARDs)
• Conventional DMARDs (cDMARDs)
• Biological DMARDs (bDMARDs)
• Target synthetic DMARDs (tsDMARDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

3 Dx tests for RA?

A

(1) X-ray: characteristic findings

(2) Synovial fluid aspriation:
- sterile, turbid synovial fluid
- decreased viscosity
- inclusion-bearing neutrophils

(3) Blood test:
antiCCP and rheumatoid factor**

17
Q

What causes gout?

A

excessive uric acid within tissues and body fluids

Monosodium urate crystals precipitate = acute inflammatory reaction

18
Q

Elevated uric acid levels must always lead to gout. True or False?

A

False

elevated level of uric acid is an essential component of gout, not all such persons develop gout

genetic and environmental factors also contribute to its pathogenesis.

19
Q

What metabolic imbalance causes gout?

A

Over production of uric acid

Under excretion of uric acid

20
Q

What are the 2 categories of gout and what is the difference?

A

Primary and secondary

Primary = Idiopathic or inborn metabolic enzymatic defect

Secondary = known dominant cause

21
Q

What are some causes of secondary gout?

A

Diseases with increased nucleic acid turnover—e.g., leukemias

Chronic renal disease (reduce excretion of urate)

Inborn metabolic disease e.g. Lesch- Nyhan syndrome or HGPRT deficiency

22
Q

histological morphology of acute gouty arthritis?

A

Dense NEUTROPHILIC infiltrate at synovium

Long, slender needle-shaped monosodium urate crystals

Edema

23
Q

What is the histological morphology of chroni tophaceous arthritis due to gout?

A

Repetitive precipitation of urate crystals during acute attacks :

  • Articular surface ENCRUSTED with urate crystal
  • Heavy urate deposit in synovium
  • Pannus formation*: hyperplastic, fibrotic, juxtaarticular bone erosion
24
Q

How does gout affect the kidneys?

A

Gouty neuphropathy

Renal Calculi

Pyelonephritis due to urinary obstruction

25
Q

What is are the normal metabolic pathways that produce uric acid?

A

Uric acid = end product of purine catabolism

• de novo pathway = synthesis of
purine nucleotides from nonpurine precursors.

• salvage pathway = synthesis of
purine nucleotides from free purine bases from
diet and purine nucleotides

26
Q

What are some predisposing factors of gout?

A

Male sex
After age 30
obesity, alcoholism, purine-rich foods, diabetes
renal failure

27
Q

What are the 4 stages of gout?

A 
(1) asymptomatic
hyperuricemia, 
(2) acute gouty arthritis, 
(3) “intercritical”
gout, 
(4) chronic tophaceous gout.
28
Q

What are the symptoms of acute gouty arthritis?

A

sudden onset
monoarticular joint pain
localized erythema, and warmth

29
Q

Definitive Dx of gouty arthritis?

A

urate crystals in the joint (by arthrocentesis)

30
Q

Genetic risk, Tissue affected, Joints affected in Ankylosing spondylitis?

A
  • HLA- B27
  • Pathologic changes in LIGAMENTS to spine
  • Involvement of SACROILIAC JOINT + arthritis in peripheral joints
  • XR BAMBOO SPINE
    Bamboo spine due to hyperintense inflammation and spinal bone formation
31
Q

Apart from RA, name another type of autoimmune joint disease?

A

Psoriatic arthritis

32
Q

Name a type of infective joint disease?

A

Dactylitis

33
Q

What causes Dactylitis?

A

1) infection of the fatty pad of a single finger or toe, arise from skin infection
2) Spondyloarthritis causing joint swelling (RA doesn’t cause Dactylitis)
3) Advanced psoriatic arthritis
4) Syphilis
5) Sickle cell disease
6) TB & Sarcoidosis (extremely rare)

34
Q

Which types of arthritis are linked to enthesitis?

A

Psoriatic arthritis
Ankylosing spondylitis
juvenile RA

Not linked to Osteoarthritis or RA

35
Q

extra-articular conditions caused by spondyloathropathy?

A
  • Eye: uveitis
  • Cardiac: aortic regurgitation
  • Lung: apical fibrosis
36
Q

What are the treatment options for Spondyloarthropathies?

A

1) NSAIDs
2) Conventional DMARDs for peripheral arthritis
3) Biological DMARDs for axial joints
4) Physiotherapy

37
Q

How to DDx different types of arthritis?

A

Poly-, oligo- or monoarthritis

Symmetrical or Asymmetrical

Large or small joints

Blood test, synovial fluid aspiration, Xray, MRI results

MBBS II MSS (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions