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IM IMMUNO/RHEUMA > RA > Flashcards

RA Flashcards

1
Q
  • chronic inflammatory disease of unknown etiology characterized by a symmetric polyarthritis
  • results in articular cartilage and bone destruction and functional disability
A

Rheumatoid Arthritis

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2
Q

are routinely included with rheumatoid factor in the diagnostic evaluation of patients

A

Serum antibodies to cyclic citrullinated peptides (anti-CCPs)

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3
Q

CLINICAL FEATURES

A
  • incidence increases between 25 and 55 years of age
  • plateaus until the age of 75 and then decreases
  • early morning joint stiffness lasting more than 1 h that eases with physical activity
  • earliest involved joints are typically the small joints of the hands and feet
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4
Q

Initial pattern of joint involvement of RA may be:

A
  • monoarticular, oligoarticular (<4 joints),
  • polyarticular (>5 joints)
  • symmetric distribution
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5
Q

patients with inflammatory arthritis who present with too few affected joints to be classified as having RA

A

undifferentiated inflammatory arthritis

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6
Q

an undifferentiated arthritis who are most likely to be diagnosed later with RA have

A
  • higher number of tender and swollen joints
  • positive for serum rheumatoid factor or anti-CCP antibodies
  • high scores for physical disability
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7
Q

an undifferentiated arthritis who are most likely to be diagnosed later with RA have

A

Flexor tendon tenosynovitis

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8
Q

Most frequently involved joints of RA:

A
  • Wrists
  • metacarpophalangeal (MCP)
  • proximal interphalangeal (PIP) joints
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9
Q

is clinically noteworthy because of its potential to cause compressive myelopathy and neurologic
dysfunction.

A

Atlantoaxial involvement of the cervical spine

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10
Q

RA rarely affects the

A

thoracic and lumbar spine.

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11
Q

occur commonly in px with RA, but they are generally not associated with significant symptoms. or functional impairment

A

Radiographic abnormalities of the temporomandibular joint

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12
Q

most frequently observed extraarticular manifestations

A
  • Subcutaneous nodules
  • secondary Siogren’s syndrome
  • interstitial lung disease (ILD)
  • pulmonary nodules
  • anemia
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13
Q

CONSTITUTIONAL Ssx of RA

A
  • weight loss
  • fever
  • Fatigue
  • Malaise
  • depression, and in the most severe, cachexia
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14
Q
  • reported to occur in 30-40% of patients
  • When palpated, the nodules are generally firm; nontender; and adherent to periosteum, tendons, or bursae
A

Subcutaneous nodules

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15
Q

Defined by the presence of either:
- keratoconjunctivitis sicca (dry eyes)
- xerostomia (dry mouth) in association with another connective tissue disease, such as RA.

A

secondary Sjdgren’s syndrome

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16
Q

the most common pulmonary manifestation of RA, may produce pleuritic
chest pain and dyspnea, as well as a pleural friction rub and effusion

A

Pleuritis

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17
Q

Pleural effusions tend to be exudative with increased numbers of

A

monocytes and neutrophils.

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18
Q
  • may also occur in px with RA and is heralded by symptoms of dry cough and progressive shortness of breath
  • can be associated with cigarette smoking and is generally found in patients with higher disease activity
A

ILD

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19
Q

Diagnosis of ILD is readily made by ___which shows infiltrative opacification in the periphery of both lungs

A

high resolution chest computed tomography (CT) scan

20
Q

are the main histological and radiologic patterns of ILD.

A

Usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP)

21
Q

causes progressive scarring of the lungs that produces on chest CT scan honeycomb changes in the periphery and lower portions of the lungs.

A

UIP

22
Q

In contrast, the most common radiographic changes in ___ are relatively symmetric and bilateral ground glass opacities with associated fine reticulations, with volume loss and traction bronchiectasis

A

NSIP

23
Q

Is defined by the clinical triad of neutropenia, splenomegaly, and nodular RA and is seen in <1% of patients, although its incidence appears to be declining in the face of more aggressive treatment of the joint disease.

A

Felty’s syndrome

24
Q
  • most common cause of death in patients with RA
  • incidence of coronary artery disease and carotid atherosclerosis is higher in RA patients than in the general population
A

Cardiovascular Disease

25
Q

more common in patients with RA than an age- and sex-matched population, with prevalence rates of 20-30%

A

Osteoporosis

26
Q

Men and postmenopausal women w/ RA have lower mean serum testosterone, LH, and dehydroepiandrosterone (DHEA) levels than control population

A

Hypoandrogenism

27
Q

RA occurs more commonly in

A

females

28
Q

The alleles known to confer the greatest risk of RA are located within

A

major histocompatibility complex (MHC)

29
Q

Most, but probably not all, of this risk is associated with allelic variation in the ___, which encodes the MHC II B- chain molecule.

A

HLA-DRB1 gene

30
Q

non-MHC genes contributing to the risk of RA is the gene encoding

A

protein tyrosine phosphatase non-receptor 22 (PTPN22)

31
Q

gene is another risk allele that encodes an enzyme involved in the conversion of arginine to citrulline and is postulated to play a role in the development of antibodies to citrullinated antigens

A

peptidyl arginine deiminase type IV (PADI4)

32
Q

Has been associated with RA only in Asian populations

A

Polymorphism in PADI4

33
Q

confers a relative risk for developing RA of 1.5-3.5

A

smoking

34
Q

women who smoke cigarettes have a nearly 2.5 times greater risk of RA, a risk that persists even ___ after smoking cessation.

A

15 years

35
Q

may play a role in the pathogenesis of RA

A

Periodontitis

36
Q

Multiple studies provide evidence for a_ link between anti-CCP positive RA and _ cigarette smoking, periodontal disease, and the oral microbiome, specifically

A

Porphyromonas gingivalis

37
Q

Classification Criteria for Rheumatoid Arthritis

JOINT INVOLVEMENT

  • 1 large joint (shoulder, elbow, hip, knee, ankle)
    involvement
  • 2-10 large joints
  • 1-3 small joints (MCP PIP thumb IP MTP wrists)
  • 4-10 small joints
  • > 10 joints (at least 1 small joint)
A
  • 0
  • 1
  • 2
  • 3
  • 5
38
Q

Classification Criteria for Rheumatoid Arthritis

Serology
- Negative RF and negative ACPA
- Low-positive RF or low-positive anti-CCP
antibodies (<3 times ULN)
- High-positive RF or high-positive anti-CCP 3 antibodies (>3 times ULN)

A
  • 0
  • 2
  • 3
39
Q

Classification Criteria for Rheumatoid Arthritis

Acute Phase Reactants
- Normal CRP and normal ESR reactants
- Abnormal CRP or abnormal ESR

A
  • 0
  • 1
40
Q

Classification Criteria for Rheumatoid Arthritis

Duration of Symptoms
- <6 weeks
- >/= 6 weeks

A
  • 0
  • 1
41
Q
  • Patients with systemic inflammatory diseases such as RA will often present with elevated nonspecific inflammatory markers such
A

ESR or CRP

42
Q

is important in differentiating RA from other polyarticular diseases

A

Detection of serum RF and anti-CCP antibodies

43
Q

has been found in 75-80% of patients with RA

A

Serum IgM RF

44
Q

Showing the most value for predicting worse outcomes

A

anti-CCP antibodies

45
Q

Synovial fluid white blood cell (WBC) counts can vary widely, but generally range between ___ WBC/uL compared to <2000 WBC/uL for a noninflammatory condition such as osteoarthritis

A

5000 and 50,000

46
Q

is the most common imaging modality, but it is limited to visualization of the bony structures and inferences about the state of the articular cartilage based on the amount of joint space narrowing

A

Plain x-ray

47
Q

offer the added value of detecting changes in the soft tissues such as synovitis, tenosynovitis, and effusions, as well as providing greater sensitivity for identifying bony abnormalities

A

MRI and ultrasound techniques

IM IMMUNO/RHEUMA (9 decks)

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