Rheumatoid Arthritis

Question 1

what is a normal immune response?

Answer 1

acute and chronic response
resolution

Question 2

what are the potential problems associated with the immune response?

Answer 2

-bystander damage
-non resolution
-self-recognition and attack

Question 3

what is autoimmunity?

Answer 3

loss of immunological tolerance to self

Question 4

what is tolerance?

Answer 4

controlled unresponsiveness to self (despite the capacity to do so)

Question 5

how common are autoimmune diseases?

Answer 5

5% of population, 1 in 20

Question 6

what are the various meachanisms that result in autoimmunity?

Answer 6

-dysfunction in tolerance
-presentation of self antigens
-molecular mimicry
-loss of regulatory mechanisms

Question 7

how many hits generally do we need to develop autoimmunity?

Answer 7

2 hit hypothesis

Question 8

what are the effects of endocrine cells autoimmunity?

Answer 8

diabetes, hyperthyroidism, Addisons disease and premature ovarian failure

Question 9

what is. the effect of autoimmunity on the liver?

Answer 9

autoimmune hepatitis, primary biliary cirrhosis

Question 10

what is the effect of autoimmunity on the bowel?

Answer 10

pernicious anaemia, inflammatory bowel disease

Question 11

what is the effect of autoimmunity on the kidneys?

Answer 11

nephritis, glomerulonephritis

Question 12

what is the effect of autoimmunity on the joints?

Answer 12

rheumatoid arthritis

Question 13

what is the effect of autoimmunity on the skin?

Answer 13

vitiligo, pemphigus, psoriasis

Question 14

what is the effect of autoimmunity on the eyes?

Answer 14

scleritis, karatitus, uveitis

Question 15

what is the effect of autoimmunity on the nervous system?

Answer 15

MS

Question 16

what is rheumatoid arthritis?

Answer 16

most common inflammatory arthritis, widespread joint pain, stiffness and swelling leading to joint destruction

Question 17

how prevelant is RA?

Answer 17

0.8% of UK

Question 18

who has a higher risk of developing RA?

Answer 18

females, 2-3x greater than males

Question 19

what are the symptoms of RA?

Answer 19

joint pain
stiffness
joint swelling
fatigue
systemic
weight loss
fevers
extra articularfeatures

Question 20

what does RA affect?

Answer 20

synovial tissue, lining of joints
-can also affects extra articular manifestations

Question 21

what is the systemic autoimmunity phase before arthritis?

Answer 21

-onset is unclear
-autoantibodies
-increased cytokines and chemokine
-altered cholesterol metabolism

Question 22

what is rheumatoid factor (RF)?

Answer 22

antibody directed against Fc or IgG

Question 23

what is anti-CCP antibodies/ACPA?

Answer 23

CCP- cyclic citrullinated peptide
ACPA - anti citrullinated protein antibodies
citrulline replaces arginine (post translational modifications)

Question 24

why does joint inflammation start?

Answer 24

-unclear (maybe permeably or citrullinated. peptides)
-activated monocytes/macrophages, neutrophils, osteoclasts
-release cytokines and chemokine which lead to damage

Question 25

how is RA treated?

Answer 25

-NSAIDs -corticosteroids -DMARDs conventional synthetic DMARDs (csDMARDs0 biologics (biological DMARDs/ bDMARDs0 small molecule inhibitors (tsDMARDs) -combinations are better than single drug

Question 26

what are NSAIDs?

Answer 26

non steroidal anti-inflammatory drugs

Question 27

what are DMARDs?

Answer 27

disease modifying anti-rheumatic drugs

Question 28

what are some of the commonly used DMARDs for RA?

Answer 28

-methotrexate -sulphasalazine -leflunomide -gold -hydroxychloroquine -cyclosporin -azathioprine -penicillamine (non specific immune suppressing drugs)

Question 29

what are biological agents?

Answer 29

drugs such as monoclonal antibodies, receptors or peptides, which have been developed rationally by targeting processes important in disease pathogenesis eg cytokines, T cells and B cells

Question 30

how id TNF- a pivotal in RA?

Answer 30

-ability to block cytokine signalling via its receptor -TNF seen as 'conductor' of pathology in RA

Question 31

what are the remaining uncertainties of biosimilars?

Answer 31

-longterm efficacy and safety -immunogenecity -interchangeability -many are made by non traditional pharmaceutical companies eg Samsung

Question 32

what are some examples of biological agents?

Answer 32

infliximab adalimumab

Question 33

what are some examples of DMARDs?

Answer 33

methotrexate leflunomide sulfasalazine

Question 34

what is an example of a corticosteroid?

Answer 34

prednisolone

Question 35

what would a radiograph of RA show?

Answer 35

joint space narrowing cartilage loss osteopenia

Question 36

what are subcutaneous rheumatoid nodules?

Answer 36

systemic symptom fibroid necrosis of subcutaneous tissue

Question 37

which joints of the hands are generally spared by RA?

Answer 37

distal interphalangeal joints

Question 38

what would analysis of synovial fluid form a RA affected joint show?

Answer 38

high protein levels >50% increased neutrophils

Question 39

what is rheumatoid factor?

Answer 39

an autoantibody found in 80% of RA cases

Question 40

what does the swan neck deformity affect?

Answer 40

proximal interphalangeal (PIP) joint hyperextension and the distal interphalangeal (DIP) joint flexion

Question 41

what is sulfasalazine?

Answer 41

combination of sulfapyridine and 5-aminosalicyclic acid used for RA treatment (csDMARD

Question 42

what is an antibody more specific to RA than rheumatoid factor?

Answer 42

anti-cyclic citrullinated peptide

Question 43

what is pannus?

Answer 43

synovial tissue proliferation which leads to cartilage destruction and joint ankylosis

Question 44

what kind of Ig is a classic lab finding in RA?

Answer 44

IgG