Rheumatoid arthritis 2

Question 2

Does having the ACPA antibody guarantee getting RA?

Answer 2

No

Question 3

ACPA antibody and RA severity?

Answer 3

ACPA can predict erosive and progressive, more severe, disease

Question 4

Are rheumatoid factor and ACPA the only RA antibodies?

Answer 4

no, but they are the most commonly used for diagnosis

Question 5

Healthy joint structure?

Answer 5

Both bones are coated in cartilage
Synovial fluid is present (secreted by synovial membrane)
Encased by a joint capsule

Question 6

Role of cartilage in joints?

Answer 6

Allows joints to glide over one another

Question 7

Role of synovial fluid in joints?

Answer 7

To lubricate

Question 8

Where is the inflammation in RA?

Answer 8

Synovial membrane

Question 9

Which cytokines cause synovial membrane inflammaiton?

Answer 9

TNFalpha, IL6, IL1

Question 10

What causes RA swelling?

Answer 10

Thickening of synovial membrane, and extra fluid being secreted

Question 11

What happens if initial RA swelling is “left unchecked”?

Answer 11

Loss of cartilage, restricted movement and damage that is irreversible

Question 12

What happens to the synovial pathology in RA over time?

Answer 12

Lymphoid infiltrates initially, leading to pannus

Question 13

What is pannus in RA?

Answer 13

Fibrin deposition in and around the cartilage damage

Question 14

Is RA symmetrical?

Answer 14

Yes

Question 15

Which larger joints are affected to a lesser extent by RA?

Answer 15

Hips and knees

Question 16

Which symptoms are described more than pain by RA patients?

Answer 16

Stiffness, fatigue, malaise

Question 17

Which joints are always affected in RA?

Answer 17

Feet and hands

Question 18

What are swan neck changes?

Answer 18

Hyperextension and flexion of different finger joints, leading to an S shape forming

Question 19

Ulnar deviation?

Answer 19

Bending of the fingers towards the little finger

Question 20

What is a rheumatoid nodule?

Answer 20

Immune deposit on the elbow associated with rheumatoid factor presence

Question 21

Indication of RA on the skin?

Answer 21

Vasculitis–> blood vessel inflammation

Question 22

Indication of RA in the eyes?

Answer 22

Scleritis, episcleritis

Question 23

What do scleritis and episcleritis affect?

Answer 23

The eye–> white part

Question 24

Indication of RA on the lungs?

Answer 24

Fibrotic changes–> coughs and breathlessness
Nodules in the lungs

Question 25

How is disease activity in RA assessed?

Answer 25

FUnctional questionnaires, blood tests, ask patient how they feel

Question 26

What are X rays used to see in RA assessment?

Answer 26

How progressive or destructive an arthritis is

Question 27

Radiological evidence of early RA?

Answer 27

Soft tissue swelling, narrowing of joint space, loss of cartilage

Question 28

Difference of bone edges between RA and healthy?

Answer 28

RA joint bones are eroded, healthy are smooth

Question 29

Pros and cons of MRI?

Answer 29

Can see more, but is expensive, slow

Question 30

Two tests good at looking at active inflammation?

Answer 30

Ultrasound and MRI

Question 31

Why are ultrasound and MRI tests good at looking at active inflammation?

Answer 31

They look at the soft tissues

Question 32

What are doppler images used to look at?

Answer 32

The flow of fluid--> i.e. blood through the synovium

Question 33

Methods of evaluation of RA?

Answer 33

Radiography, physical examination, laboratory, subjective

Question 34

What can indicate high levels of IL6?

Answer 34

An increase in C-reactive protein

Question 35

Targets of most potent drugs used in RA?

Answer 35

Cytokines--> anti TNF,

Question 36

How is TNF targeted?

Answer 36

Block receptors, remove it itself

Question 37

Why are B cells targeted to prevent an inflammatory response?

Answer 37

Stops the downstream activation of t cells

Question 38

What is DAS28?

Answer 38

DAS28 provides a number on a scale from 0 to 10 which indicates the current activity of the disease

Question 39

DAS28 of over 5.1?

Answer 39

High disease activity

Question 40

DAS28 of less than 3.2?

Answer 40

Low disease activity

Question 41

DAS28 of less than 2.6?

Answer 41

Remission

Question 42

HAQDI scoring?

Answer 42

Patients report how much difficulty they are having in performing various activities

Question 43

HAQDI numbers meaning?

Answer 43

0-3 W/o any difficulty, w/ some, w/ much, unable to do

Question 44

Prognosis of RA?

Answer 44

Treatment is tailored depending on severity, and for most it is mild

Question 45

RA comorbidities?

Answer 45

Circulatory, respiratory, digestive, genito-urinary, malignant neoplasm

Question 46

Indicators of poor RA outcomes?

Answer 46

HLA-DRB1 gene, high ESR or CRP level at outset, +ve RF and ACPA, mant active joints, poor functional scores