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Pathophysiology II - MSK > Rheumatoid > Flashcards

Rheumatoid Flashcards

1
Q

T/F: Acute Rheumatic diseases are often spontaneously initiated

A

False

They are typically onset from an outside force like infection, medications, or exposure

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2
Q

Are acute rheumatic diseases typically self-limiting?

A

Yes

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3
Q

Chronic rheumatic disease typically occurs as a result of what?

A

An autoimmune response

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4
Q

Once a disease establishes flares of chronic rheumatic disease, those flares become _________ (less frequent/more frequent)

What is this a result of?

A

More Frequent

Likely the result of immune system memory

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5
Q

How is the endothelium involved in the initiation of a rheumatic response?

What happens to neutrophils and monocytes during this time?

A

Regional Blood vessel endothelium is activation by pro-inflammatory cytokines

The endothelium expresses ligands (attachment sites) for inflamatory cell markers (integrins) which allow neutrophils and monocytes to preform diapedesis into the underlying tissues

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6
Q

Antibody-antigen complexes are _________ (activators/deactivators) of the complement cascade

A

Activators

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7
Q

When the complement cascade is activated……

It ________ (attracts/repels) additional imflammatory cells

It ________ (Increases/Decreases) cell permeability which ________ (Increases/Decreases) inflammation

A

Attracts

Increases
Increases

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8
Q

Helper T1 cells activate _________ which increase __________

A

Macrophages

Phagocytosis

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9
Q

Helper T2 cells activate ________ which increases what?

A

B-Cells

Increases Antibody Production

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10
Q

Helper T-17 cells activate __________ and ________ ________

A

Granulocytes

Autoimmune Mechanisms

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11
Q

T/F: In some tissues, cells that ordinarily are unrelated to the immune response can alter their form and function to become part of a chronic inflammatory response.

A

True

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12
Q

What condition involves crystal induced inflammation in synovial joints?

A

Gout

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13
Q

What crystals are typically responsible for gout?

A

Monosodium urate

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14
Q

What joints does gout primarily effect?

A

Great Toe
Midfoot
Ankle
Knee

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15
Q

What is the name for the collections of urate crystals that collect in joint spaces in gout?

A

Tophi

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16
Q

What are TWO common ways people develop gout and hyperuricemia?

A 
Under Excretion (90%)
Over Production (10%)
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17
Q

Only about ___% of people with hyperuricemia will develop gout

A

10%

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18
Q

What increases your risk for developing gout?

A 
Metabolic Syndrome
High-Purine Diet
Obesity
Renal Disease
Heart Disease
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19
Q

How does a patient develop a gout ‘flare’?

A
  1. Uric acid crystals precipitate in a joint
  2. IL-1 and TNF activate the endothelium and inflammatory mediator come into the joint
  3. Complement gets activated leading to more inflammation
  4. Inflammation builds even more with phagocytosis, degranulation, free radical release/damage, and protein destruction with proteinases
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20
Q

What medications can reduce joint inflammation in gout flares?

A

NSAIDs
Steroids
Colchicine

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21
Q

What are THREE ‘lifestyle’ changes that can prevent future gout attacks?

A

Loss Weight
Decrease Protein in diet
Control Co-morbid conditions (HTN, BP, Met-S)

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22
Q

How does colchicine work in gout?

A

It is a microtubule poison, so WBC can not squeeze through the small endothelial spaces into joints and produce inflammation

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23
Q

Which rheumatic disease is characterized by joint inflammation, pain, and swelling, with a prevalence for joint destruction, a higher mortality, and an unknown trigger?

Women are more effected by this than men by a 3:1 ratio

A

Rheumatic Arthritis

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24
Q

What are the THREE most common joints effected by RA?

A

Wrist
MCP
MTP

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25
Q

A _________ is a membrane of granulation tissue made of mesenchyme and bone-marrow derived cells that forms in the joints during chronic RA.

This stimulates the release of what?

A

Pannus

This stimulates the release of cytokines (ex: IL-1, Prostagladins, Substance P) by macrophages leading to cartalige destruction and bone erosion

26
Q

What is the most sensitive antibody test for RA?

A

Anti-CCP

27
Q

Which antibody is present in about 50% of RA patients?

A

Rheumatoid Factor (RF)

28
Q

Which gene is associated with Anti-CCP and RA?

What lifestyle habit is also associated with the above two things?

A

HLA-DRB1

Smoking

29
Q

T/F: There is a foolproof blood test to diagnosis RA

A

False

There is not

30
Q

What are extra-articular manifestations of RA?

A 
Sicca Syndrome (Sjogren's) 
Pericarditis
Pleuritis
Pulmonary Fibrosis
Ocular Inflammation
Neuropathies
Vasculitis
31
Q

Methotrexate is an inhibitor of what?

A

Dihydrofolate Reductase (DHFR)

Inhibits the creation of new DNA and lowers the number of inflammatory cells that exist

32
Q

Methotrexate __________ (increases/decreases) apoptosis of T-Cells

A

Increases

33
Q

How does Methotrexate alter the endothelial cascade?

A

Decreases attachment site for WBCs thus decreasing diapedesis

34
Q

What disease is described as a degenerative disease of joint cartilage and the bone beneath it?

A

Osteoarthritis

35
Q

Osteoarthritis involves the degradation of a certain protein in cartilage…..

What is the name of this protein?

A

Proteoglycans

36
Q

In what type of joints does osteoarthritis tend to be worse in?

A

Weight Bearing Joints

Work-Stressed Joints

37
Q

A key feature of osteoarthritis is the formation new bony outgrowths called what?

A

Osteophytes (Bone Spurs)

38
Q

Osteoarthritis can be confirmed using what imaging modality?

What are some findings that would be consistent with that Dx?

A

XR

Jointspace narrowing
Increased bone formation around the joint
Subchondral cystformation
Osteophytes

39
Q

What is the name of the rheumatic disease that primarily effects the spine?

A

Ankylosing Spondylitis

40
Q

What portions of the spine are primarily effected in ankylosing spondylitis?

A

The Ligaments and Joints of the spine become inflamed leading to stiffness

41
Q

Can the joints and bones become fused together in ankylosing spondylitis?

A

Yes

42
Q

Other than a H&P and XR, what gene is present in Ankylosing Spondylitis that is helpful with diagnosis?

A

HLA-B27

43
Q

What DMARD can be used in ankylosing spondylitis?

What NSAID?

A

DMARD: Sulfasalazine

NSAID: Indomethacin

44
Q

Are men or women more likely to develop SLE?

Is it more prevelant in afirican americans of caucasians?

A

Women

African Americans

45
Q

What is the ‘common thread’ in SLE?

A

Defect in the suppression of the complement cascade

This leads to recurring inflammation due to the inability to break down apoptotic cells

46
Q

To be diagnosed with SLE, patients need to have __ of the ___ criteria present either serially or simultaneously

A

4 of the 11 criteria

47
Q

What is the most common presenting symptoms in lupus?

This is prevalent in about 85%of cases

A

Malar Rash

48
Q

Which rash associated with SLE can be disfiguring?

A

Discoid Rash (Scarring)

49
Q

Patients with SLE can have _________ (Painful/Painless) oral ulcers

A

Painless

50
Q

Polyarthritis occurs in ___% of SLE patients

While joint deformities occur in __% of SLE patients

A

90%

10%

51
Q

What are pulmonary manifestations of SLE?

A

Pleuritis (If mild treat with NSAIDS)
Serositis (interstitial inflammation, can lead to pulmonary fibrosis)
PTX
Pulmonary HTN

52
Q

What is a renal manifestation of SLE?

This is commonly seen with proteinuria

A

Nephritis

53
Q

What are examples of neurological manifestations of lupus?

A 
Neuropathy
Memory Impairment 
Headache
Seizures
Pychosis
54
Q

SLE patients (especially women under 45) have a 50x increased risk for what?

A

TIA

CVA

55
Q

Which antibody is positive in 95% of SLE cases but is NOT specific to SLE?

A

+ ANA

56
Q

Which antibody is very specific to SLE?

A

Anti-dsDNA IgG

57
Q

Which antibody is only present in 25% of SLE cases?

A

Antu-Sm

58
Q

Which antibody is not very specific to SLE but can be helpful in identifying those with an increased clotting risk?

A

APLA

59
Q

Which medication class is commonly used to control pain and swelling in SLE patients?

Although it can put SLE patients at an increased risk for what?

A

NSAIDs

This can lead to an increased risk for aseptic meningitis in SLE patients

60
Q

Which antimalarial is often used in SLE?

A

Hydroxycholoroquine

61
Q

What medication class is used to rapidly suppress inflammation in SLE flares?

A

Corticosteroids:

Prednisone
Hydrocortisone
Methylprednisolone
Dexamethasone

62
Q

What medication class is reserved for SLE patietns with CNS and renal involvement?

A

Immunosuppressants:

Methotrexate
Cyclosporine (can lead to more kidney damage)
Cellcept
Imuran

Pathophysiology II - MSK (4 decks)

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