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HDT 3.1 > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

What is RA?

A

autoimmune, systemic, inflammatory disease
chronic, persistant synovial inflammation = destroys articular cartilage and bone = decline joint function

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2
Q

what are the common symptoms of RA?

A
  • symmetrical polyarthritis
  • pain and swelling
  • affecting small joints of the hands and feet
  • morning stiffness
  • improves with activity (ideally)
  • debilitating fatigue
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3
Q

what are the clinical symptoms of RA?

A
  • increase level of acute phase reactants (CRP)
  • increase level of erythrocyte sedimentation rate (ESR)
  • autoantibodies for RA (RF) and anti-citrillinated protein autoantibodies (ACPA)
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4
Q

what joints does RA affect?

A

MCP joints
PIP joints
MTP joints

professing to the wrists, ankles, knees

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5
Q

what is the pathology of OA?

A

thin cartilage
bones rub together

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6
Q

what is the pathology of RA?

A

swollen inflamed synovial membrane
bone erosion

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7
Q

why is RA scary (arghhh)?

A

decreased life expectancy due to co morbidities

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8
Q

what co-morbidities are associated with RA?

A

-atheroscloersis and heart disease
-vasculitis
-lung inflammation and resultant scarring
-infection risk due to immunosuppressant treatment (ANTI- TNF-a, corticosteroids)
-high risk of lung cancer and lymphoma

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9
Q

what lifestyle advice would you advise for RA pt’s?

A

stop smoking
control weight
blood pressure
cholesterol
early and effective treatment to reduce symptoms to reduce systemic inflammation

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10
Q

what is the criteria to diagnose RA?

A

score >6/10

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11
Q

what are the risk factors of RA?

A

-age
-female
-genetic predisposition - hereditary/HLA-DBR-1 gene variant

environmental factors
-smoking
-dust/silica exposure
-microbes

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12
Q

what is the HLA-DBR-1 gene variant responsible for?

A

it does not result in RA, but increases the risk factors majorly for RA

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13
Q

what are RF’s?

A

autoantibodies that recognise Fc portion of IgG for RA known as rheumatoid factors

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14
Q

what tool is used to diagnose RA?

A

The anticyclic citrullinated peptide (anti-CCP) assay broadly detects antibodies against citrullinated proteins (ACPAs) and has high specificity and excellent sensitivity in RA

known as RF’s

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15
Q

what risk factors increase APCA formation?

A

-periodontal tissue bacteria
-lung smoke/air pollutant
-intestinal bacteria

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16
Q

how is APCA produced?

A

T cell stimulates B cell to produce autoantibodies

17
Q

why is early detection important

A

as early treatment showed lower levels of disease progression

18
Q

what cells migrate into the joint from the blood in RA?

A
  1. neutrophils
    - early in inflammation produces IL-17 cytokines
  2. dendritic cells
    -activates T cells w antigen produces IL-12, IL-23 turn T cell on IL-10 T cell off
  3. effector cells
    -help b cells make antibodies
  4. b cells
    -make antibodies
  5. regulatory cells
    -make IL-10 to turn off immune response
19
Q

what cells are in the joint?

A

1.Chondrocytes
-Make metalloproteinase enzymes to degrade cartilage
2. Fibroblast-like synovial cells
-Make metalloproteinase enzymes and invade and degrade cartilage and bone. Secrete cytokines e.g. IL6 to attract and retain leukocytes in the joint
3. Macrophage
-Make lots of cytokines to activate osteoclast and immune cells
4. Osteoclast
-Make enzymes and degrade bone
5. Mast cells
-Make vasoactive factors that attract immune cells to the joint
6. Adipocytes
-Make anti-inflammatory adipokines (e.g. leptin)

20
Q

what are the two aims of RA treatment?

A
  1. slow disease progression
  2. control symptoms
21
Q

what is DAS28 score?

A

clinical assessment to score disease activity

22
Q

what is measured in DAS28?

A
23
Q

what does a high/low/remission score in RA?

A
24
Q

what are disease modifying anti-rheumatic drugs (DMARD)

A
25
Q

what drugs are given in RA ?

A

DMARD
MTX
TNF-a inhibitors -infliximab
anti-b cell therapy

26
Q

why is MTX used in RA?

A

Inhibits activation of B and T cells

27
Q

side effects of MTX?

A

Sickness, loss of appetite, sore mouth, diarrhoea, headaches and hair loss
Can affect blood count and liver
Less commonly, can affect lungs

28
Q

what is the treatment plan for pt’s with RA?

A

HDT 3.1 (13 decks)

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