RA

Question 1

what hand joints are affected first in RA

Answer 1

MCPs and PIPs

Question 2

where do you see lyphocytic infiltration in RA

Answer 2

synovium

Question 3

which specific lymphocytes are most common in RA

Answer 3

TH17

Question 4

does synovium have a basement membrane

Answer 4

no

Question 5

what are most synoviocytes

Answer 5

fibroblast-like connective tisue cells

Question 6

where is synovial membrane in the joint

Answer 6

at the sides, also continues straight into articular cartilage

Question 7

what are the minority of synoviocytes

Answer 7

macrophage-like cells

Question 8

describe normal synovial fluid appearance

Answer 8

acellular
straw coloured

Question 9

what are the only cells which are normally, sparsely in synovial fluid

Answer 9

primarily neutrophils and a few macrophages

Question 10

what are the 2 tests on synovial fluid? what do they suggest?

Answer 10

string test - string should be 4-6 cm
clot test - should be clear fluid, solid clot

Question 11

which cells proliferate in RA in the synovium. What is the consequence

Answer 11

macrophage-like synoviocytes++ and fibroblast-like sunoviocytes creating many more layers of synovium than the normal 1-3

Question 12

which inflammatory cells go where in RA

Answer 12

neutrophils - synovial fluid
lymphocytes - subintima

Question 13

synovial joints have a rich network of what sort of capillafies

Answer 13

fenstrated

Question 14

what is this sign of RA, what is it

Answer 14

Pannus, hyperplasia of synovial membrane creates kind of villi as the membrane folds on itself

Question 15

what to type A cells differentiate into in active RA

Answer 15

they are similar to macrophages, so easily pushed into osteoclasts

Question 16

MMPs are important/ What do they do?

Answer 16

Soften cartilage, gets eroded away, then bone is exposed leading to more erosion

Question 18

Acpa antibodies activate osteoclasts. What il do they produce in RA

Answer 18

Il 18

Question 19

What do th17 cells secrete in RA

Answer 19

Il 17

Question 20

In RA, tnf, il1 and il6 cause rankl to be produced. That induces osteoclasts activity but what also happens with osteoblasts

Answer 20

Tnf etc activate dkk1 which induces sclerostin which inhibits osteoblasts

Question 21

Ra. String test result

Answer 21

Short 1cm

Question 22

%population RA in uk

Answer 22

1%

Question 23

what are the 2 acute and 2 non-acute blood markers for RA

Answer 23

CRP/ESR actue

ACPA, RF non-acute

Question 24

in the 2010 ACR/EULAR criteria
what constitutes an RA diagnosis

Answer 24

=/> 6 points

Question 25

describe an overview of the 4 criteria for RA diagnosis in ACR/EULAR criteria

Answer 25

Question 26

what is the crucial symptom in RA

Answer 26

one swollen small joint

Question 27

RA disease tx always includes methotrexate but there are 3 different adjunct options for mild/moderate/severe disease. What are they

Answer 27

DMARD TNF alpha inhibitor (infliximab) Rituximab

Question 28

DMARD and pregnancy

Answer 28

YES, monotherapy

Question 29

pain tx for RA

Answer 29

NSAIDS and selective Cox-2 inh

Question 30

methotrexate and pregnancy

Answer 30

NO

Question 31

early DMARDS tx in RA improve two things but not the other. WHat are the three things

Answer 31

improve swollen joints, radiographic presentation do not improve fatigue

Question 32

which 2 enzymes does methotrextae inhibit

Answer 32

dihydrofolate reductase thymidylate synthetase

Question 33

2 monitoring blood tests when ongoing methotrexate tx

Answer 33

fbc lft

Question 34

methotrexate inhibts which inflammatory cytokines

Answer 34

IL1 and NF-κB

Question 35

specific HLAs with strong association to RA

Answer 35

HLA DR1 and DR4

Question 36

Dmard 4 examples

Answer 36

Sulfasalazine Methotrexate Hydroxychloroquine Leflunomide

Question 37

what is the other tnf inhibitor that isn't infliximab

Answer 37

etanercept

Question 38

what drug is a tnf binder (not blocker)

Answer 38

adalimumab

Question 39

name 3 Il1 inhibitors

Answer 39

Anakinra Canakinumab Rilonacept

Question 40

RA drug that targets T cells

Answer 40

abaTacept

Question 41

Tocilizumab inhibits..

Answer 41

Il6