RHEUM REVIEW UNDERLINED TOPICS

Question 1

In which Rheumatologic disease does exercise pose NO risk, and may even be protective?

Answer 1

OA.

Question 2

In Early OA, what happens to the number of metalloproteases present in cartilage?

Answer 2

Increases.

Question 3

Although OA is a non-inflammatory disease, which inflammatory mediators are involved?

Answer 3

Prostaglandins
Adipokines
Nitric Oxide
IL-1
Compliment Activation.

Dont PANIC with OA

Question 4

Which Rheumatologic disease is characterized SYMMETRIC SYNOVITIS which can result in cartilage and bone destruction?

Answer 4

RA.

Question 5

What is the shared epitope (in antigen binding grove) commonly involved in certain suptypes of RA? Name those subtypes.

Answer 5

QKRAA

HLA-DR4
HLA-DR1

Question 6

QKRAA is commonly involved in subtypes HLA-DR_ and HLA-DR _ of _____________ disease

Answer 6

HLA-DR4
HLA-DR1

Rheumatoid Arth.

Question 7

What is Rheumatoid factor (RF), how can it become pathogenic?

Answer 7

It is usually an IgM directed at Fc portion of an IgG.

May become pathogenic when complexed with IgG (RF-IgG)

Question 8

What are the lymphocytes found in RA synovium?

Answer 8

CD4+ Tcells and TH17 cells
B-cells and plasma cells also present

NO PMNs

Question 9

What is the purpose of CD4+ memory T cells in RA synovium?

Answer 9

Modulation and amplification of local immune response

Question 10

What is the basic pathophysiology of gout?

Answer 10

Deposition of Monosodium Urate (MSU) crystals due to MSU SUPERSATURATION of extracellular fluids.

Question 11

Hyperuricemia my be caused by two mechanisms. Name them. Which is most common in gout?

Answer 11

Over producers (10%) 
Under Excreters (90%)

Question 12

Uric acid is formed in the breakdown of __________

Answer 12

pURInes.

Question 13

What enzyme is responsible for oxidizing uric acid to allantoin in non-humans?

Answer 13

Uricase

Question 14

Uric Acid overproducers usually inherit defects in ______ and ________ genes in an ___________ inheritance pattern.

Answer 14

PRPP synthetase
HGPRT

X-linked Recessive

Question 15

In Uric Acid overproducers, which gene is associated with OVERACTIVITY of enzymes?

Answer 15

PRPP

lots of Purine metabolism; see the 3Ps

Question 16

In Uric Acid overproducers, which gene is associated with a partial deficiency of an enzyme?

Answer 16

HGPRT

H could stand for HYPO activity maybe

Question 17

What is the gold standard for diagnosing gout or crystal arthritis?

Answer 17

Arthrocentesis

Question 18

Proteins coating gout crystals modulate the immune response. Early on, crystals are covered by ________, which _________ (promotes or inihbits) phagocytosis.

Answer 18

Crystals are covered by IgG, promoting phagocytosis

Question 19

T/F Gout crystals are covered in IgG due to antigenic binding.

Answer 19

FALSE

Its due to charge interactions

Question 20

Proteins coating gout crystals modulate the immune response. Later on in the disease process, crystals are covered by ________, which _________ (promotes or inihbits) phagocytosis.

Answer 20

Apolipoprotien B, inhibits phagocytosis

Question 21

Which 3 findings are typical (according to the review) of a patient with Seronegative Spondyloarthritis?

Answer 21

1. Sacroilitus and morning stiffness
2. Enthesitis (swelling where tendons or ligaments insert into the bone)
3. Inc Levels of TNF-alpha in synovium

Question 22

What percent of people that are HLA-B27 positive get ankylosing Spondyloarthritis?

Answer 22

2%

Question 23

What percent of people that are HLA-B27 positive and have a first degree relative with ankylosing Spondyloarthritis will get the disease?

Answer 23

20%

10 fold increase

Question 24

Which disease is characterized by asymmetric, oligoarticular (few joints), arthritis in the lower extremities?

Answer 24

Reactive Arthritis

Question 25

Reactive Arthritis is characterized by....

Answer 25

Asymetric, oligoarticular arthritis in the lower extremeties.

Question 26

What is the basic pathogenesis of Systemic Lupus Erythmatosis (SLE)?

Answer 26

Misdirected recognition of self as foreign. (autoimmune)

Question 27

Which Lymphocyte(s) is/are involved in SLE?

Answer 27

Both T and B cells.

Question 28

Antibody responses toward autoantigens in SLE are ___________ and require _________ (cell)

Answer 28

Antigen Driven CD4+ T cells This means that we make selective autoantigens in lupus.

Question 29

In SLE, loss of T-cell tolerance leads to...

Answer 29

peripheral autoreactive B-cell stimulation.

Question 30

Is SLE a monogenic or polygenic disease?

Answer 30

Poly

Question 31

Which Gene is MOST associated with SLE?

Answer 31

C4A

Question 32

Although it is not specific to SLE, 95% of patients with SLE are ANA (+/-)?

Answer 32

ANA+ Antinuclear antibody

Question 33

What are the targets of antibodies in lupus?

Answer 33

MULTIPLE NUCELAR ANTIGENS including: 1. dsDNA 2. Histones 3. SSA, SSB, Smith and Ribonuclear Protein (non-DNA, non-histone antigens)

Question 34

Anti-phospholipid antibodies in SLE type II cause _________ of platelets

Answer 34

Clotting | --- Even though they are referred to Lupus Anticoagulant

Question 35

What is the pathophysiology of Vasculitis?

Answer 35

Inflammation→ PAFs (platelet activating factors)→ ↑ VASCULAR PERMIABILITY→ Immune complex deposition. Leads to palpable purpura

Question 36

Because vasculitis is thought to be T cell dependent-mediated endothelial cell injury, this suggests that that the mechanism is most likely ___________.

Answer 36

Antigen driven

Question 37

C-ANCA is generally associated with _______(protein) and ___________(disease)

Answer 37

Proteinase 3 (PR3) GPA (Wegner's disease or Granulomatosis with Polyangitis) **Remember that C's affect your GPA**

Question 38

P-ANCA is generally associated with _______(protein) and ___________(disease)

Answer 38

MPO Microsopic polyangitis (MPA) **MPA and MPO for P-ANCA**

Question 39

Polymyositis and Dermatomyositis are highly associated with

Answer 39

Interstitial Lung Disease (60%)

Question 40

Polymyositis and Dermatomyositis have Anti-aminoacyl-tRNA synthetases. Where does this antibody target?

Answer 40

Cytoplasm

Question 41

Anti-Jo-1 = anti-__________-tRNA synthetase

Answer 41

histayl

Question 42

T/F Anti-synthetase antibodies are pathologic and myotoxic antibodies.

Answer 42

FALSE They are neither pathologic nor myotoxic

Question 43

Polymyositis is associated with CD____ cells

Answer 43

CD8+ | think of polymyositis and Dermatomyositis. D comes before P and 4 before 8

Question 44

Dermatomyositis is associated with CD____ cells

Answer 44

CD4+ | (think of polymyositis and Dermatomyositis. D comes before P and 4 before 8)