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Phase 2 Limbs and Back > PBL 4 > Flashcards

PBL 4 Flashcards

1
Q

Define rheumatoid arthritis?

A

Systemic inflammatory condition due to autoimmunity

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2
Q

What part of the body does rheumatoid arthritis affect?

A

Affects multiple joints

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3
Q

What are the clinical presentations of rheumatoid arthritis?

A 
Arthritis that is symmetrical 
Pain
Swelling
Nodes around the area
Additional extraarticular involvement
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4
Q

What joint is affected early in rheumatoid arthritis?

A

Hands
Metacarpal phalangeal joint (MCP)
Proximal Interphalangeal joint (PIP)

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5
Q

How does hand involvement in rheumatoid arthritis differ from osteoarthritis?

A

RA:
Joints affected are the proximal interphalangeal joints and metacarpal phalangeal joint. Furthermore joint involvement such as the wrist
OA:
Joints affected are the distal and proximal interphalangeal joints

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6
Q

Name the progressive hand features of rheumatoid arthritis?

A
  1. Swan neck
  2. Boutonnniere
  3. Z deformity of the thumb
  4. Ulnar deviation
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7
Q

Describe the swan neck feature of a hand with rheumatoid arthritis?

A

Distal interphalgeal joint flexed

Proximal interphalageal joint hyperextension

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8
Q

Describe the Boutonniere feature of a hand with rheumatoid arthritis?

A

Distal interphalangeal joint hyperextension

Proximal interphalangeal joint flexed

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9
Q

Describe the ulnar deviation of a hand with rheumatoid arthritis?

A

Deviation of the hand medially

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10
Q

What part of the joint is inflammed during rheumatoid arthritis?

A

Inflammation of the synovium

Causing the pain and swelling of rheumatoid arthritis

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11
Q

Inflammation of the synovium leads to what secondary features of rheumatoid arthritis?

A

Bone and cartilage erosion

Angiogenesis

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12
Q

What is the trigger that causes the inflammation of the synovium, a feature of rheumatoid arthritis

A

Unknown

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13
Q

What is the pathophysiology of rheumatoid arthritis

A

In the synovium:
Macrophages begin to secrete cytokines (TNF alpha, IL1 and IL6). Leads to inflammation.
The cytokines stimulate the synoviocytes. This activates and proliferates the synoviocytes. The synoviocytes are involved in the RANKL expression. RANKL + Cytokines cause the oestoclast activity causes erosion of bone.
Synoviocytes also produce proteases which cause cartilage degradation. These degraded cartilage produce proteases which act as a positive feedback loop. Causing further cartilage degeneration.
When activated, synoviocytes can migrate to other joints (causing symmetry).
CD4 T cells are involved by stimulating RANKL expression and produce IL17 which stimulates macrophage activity and synoviocytes.
Plasma cells assist in inflammation through cytokines and antibodies
Neutrophils, found in the fluid, stimulate protease production and inflammation.
In the fluid we also find immune complexes, complex of antibodies bound to one another, and promote inflammation.

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14
Q

Describe the process in rheumatoid arthritis thats causes bone erosion?

A

Macrophages are triggered and begin to secrete cytokines (TNF alpha, IL1 and IL6).
These cytokines stimulate the activation and proliferation of the synoviocytes. These synoviocytes are involved in the RANKL expression. Which causes, along with cytokines, the stimulation of osteoclast activity causing the erosion of bone

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15
Q

What is the involvement of synoviocytes in rheumatoid arthritis?

A

Increased expression of RANKL which stimulates osteoclast.
Produce proteases which cause the cartilage to break down
When activated can migrate from joint to joint (Hence symmetry)

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16
Q

What is the feedback loop during cartilage degradation during rheumatoid arthritis?

A

When cartilage is broken down it starts to produce proteases which stimulates further cartilage degenerative

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17
Q

What is the involvement of

A

Promote inflammation. Stimulates the RANKL expression (causing bone erosion)
Secrete IL17 which stimulates macrophages and synoviocytes

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18
Q

What is the CD8 T cell?

A

Cytotoxic T cell

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19
Q

What is the CD8 T cell?

A

Cytotoxic T cell

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20
Q

What cells are involved in rheumatoid arthritis?

A 
Macrophages
CD4 T cells
Plasma cells
Synoviocytes
Osteoclasts
Neutrophils
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21
Q

What structures in the synovial fluid are involved in rheumatoid arthritis pathophysiology?

A

Neutrophils and immune complexes

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22
Q

Describe the importance of angiogenesis in rheumatoid arthritis?

A

Provides nutrient supply for these immune cells and more immune cells to migrate into the area
Cytokines also increase the permeability.

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23
Q

Describe the process of producing autoantibodies in rheumatoid arthritis?

A

Factor(s), such as smoking, genetics etc, cause modification of autoantigen. Thus this modification will be recognised by antigen presenting cells. APC will be activated and migrate to the local lymph node. It will activate CD4 T cell in the lymph node. This activated CD4 cell can costimulate the B cells in the germinal centre of the lymph node. B cells begin to proliferate and class switch and will become plasma cells. The plasma cells will produce auto-antibodies

24
Q

What are the two main types of auto-antibodies found in rheumatoid arthritis?

A

Rheumatoid factor

Anti-CCP

25
Q

Describe the rheumatoid factor antibody?

A

IgM antibody.
Found in 75% of people with rheumatoid arthritis
Target the Fc portion of the IgG, hence force the immune complexes that are found in the synovial fluid that stimulates inflammation.

26
Q

Describe the anti-CCP antibody?

A

Anti-cyclic citrullinated peptide
Present in most rheumatoid arthritis patients.
target citrullinated proteins such as fibrin.

27
Q

Describe citrullinated proteins?

A

Proteins who have arginine residues altered to citrulline. These proteins now seem foreign to the body

28
Q

How useful is rheumatoid factor and anti-CCP in diagnosing rheumatoid arthritis?

A

RF is poor as not everything with RA will have it and it is found in a lot of other conditions.
Must be tested with in addition of anti-CCP

29
Q

What is the effect of rheumatoid arthritis in the skin?

A

contributes to nodule formation

30
Q

what is the effect of rheumatoid arthritis in the liver?

A

Increase production of CRP (inflammatory marker)

Increased production of hepcidin, which contributes to anaemia

31
Q

Define anaemia?

A

Deficiency of haemoglobin in the blood

32
Q

What is the effect of rheumatoid arthritis in the cardiovascular?

A

Cytokines and inflammation promote atherogenesis (clot formation)
Increasing MI and stroke risk

33
Q

Define atherogenesis?

A

Formation of fatty deposits in the arteries

34
Q

What is the effect of rheumatoid arthritis in the brain?

A

Causes fatigue and depression (which may be as a result of the anaemia from liver involvement)

35
Q

Name the different parts of the synovial joint?

A 
Joint cavity
Joint capsule
Articular cartilage
Synovium 
Synovial fluid
Ligament
36
Q

What is the function of the joint cavity in the synovial joint?

A

Site of articulation between the two ends of the bone

Contains synovium and synovial fluid

37
Q

What is the function of the joint capsule in the synovial joint?

A

Fibrous connective tissue
Surrounds the entire joint
Attaches to each bone just outside the articular surface

38
Q

What is the function of the articular cartilage in the synovial joint?

A

Thin layer of hyaline cartilage that covers the entire articulating surface of each bone.
Allows bone to move smoothly and increases joint mobility

39
Q

What is the function of the synovium in the synovial joint?

A

Synovial membrane
Lines the inner surface of the joint capsule
Contains synoviocytes

40
Q

Describe synoviocytes and the different types?

A

A and B
Synoviocyte A: phagocytosis
Synoviocyte B: secrete synovial fluid

41
Q

What is the function of the synovial fluid in the synovial joint?

A

Viscous fluid

Reduces friction and provides nourishment to the articular cartilage

42
Q

What is the function of the ligament in the synovial joint?

A

Outside the articulating surface
Connects bones together
Band of fibrous connective tissue
Function is for stability within the joint

43
Q

Name the types of synovial joints?

A
  1. Ball and socket
  2. Hinge
  3. Condyloid
  4. Saddle
  5. Plane
  6. Pivot
44
Q

Give an example of a ball and socket joint?

A

Hip joint

45
Q

Give an example of a hinge joint?

A

Elbow joint

46
Q

Give an example of a condyloid joint?

A

Radiocarpal joint

47
Q

Give an example of a saddle joint?

A

Joint between the trapezium and the 1st metacarpal

48
Q

Give an example of a plane joint?

A

Between the tarsal bones

49
Q

Give an example of a pivot joint?

A

Atlas (C1) and axis (C2)

50
Q

What is the treatment for rheumatoid arthritis?

A 
DMARD e.g. methotrexate
Corticosteroid
NSAIDs
Physiotherapy
Biological agents
51
Q

What does coccus mean when describing bacteria?

A

Round (berry)

52
Q

What does bacillus mean when describing bacteria?

A

Rod

53
Q

What does spirillum mean when describing bacteria?

A

Spiral shaped

54
Q

What does aureus mean when describing bacteria?

A

Golden

55
Q

What does albus mean when describing bacteria?

A

White

56
Q

What does staphylo mean when describing bacteria?

A

Grape like (clusters)

57
Q

What does strepto mean when describing bacteria?

A

Twisted chain

Phase 2 Limbs and Back (31 decks)

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