Rheumatoid Arthritis Flashcards Preview

ICM Infectious Disease > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (39):
1

Pattern of RA?

Symmetric

2

Etiology of RA?

Unknown, thought to be genetic

3

What is associated with increased incidence of rheumatoid and lupus

STAT4 haplotypes chromosome 2

4

What is associated with increased risk of CCP positive RA?

TRAF1-C5 on chromosome 9

5

What does TRAF1-C5 code for?

Intracellular protein that mediates signal transduction through TNF receptors 1 and 2

6

Primary orchestrator of the cell mediated immune response in rheumatoid arthritis?

CD4 helper T-cells

7

What do patients with RA express at much greater rate than patients w/o RA?

HLA DR4 haplotypes

8

TNF, IL-1, IL-6 cause what?

Erosion of bone and cartilage

9

IL-1 and TNF do what?

Stimulate adhesion molecules
Increase recruitment of polymorphonuclear cells into the joints

10

What do polymorphonuclear cells release that degrades cartilage?

Elastase and proteases

11

Function of rheumatoid factor?

Unknown

12

How is rheumatoid factor released?

Stimulated CD4 stimulates B cells to produce immunoglobulins including rheumatoid factor

13

Function of IL-4 and IL-10?

Down regulate the inflammatory response

14

What happens to the synovial membrane in early RA?

Membrane becomes thickened due to hyperplasia and hypertrophy of synovial lining cells

15

When RA is established what does synovial membrane become?

Inflammtory tissue (pannus)

16

What is Pannus made up of?

Type A (macrophage like), type B (fibroblast like), and plasma cells

17

Constitutional features of RA?

Morning stiffness lasting for hours
Malaise, fatigue

18

Men or women more likely to get RA?

Womean 3:1 ratio

19

Peak onset of RA?

30-55

20

How do the joints feel in RA?

Joints have a warm boggy feel (soft and squishy)

21

What joint does RA never infect?

DIP

22

What does infection of DIP joints indicate?

OA or psoriatic arthritis

23

Does RA get to the lower back?

NO!

24

Finding between cardiac and RA?

Fourfold increase in cardiovascular events in rheumatoid population

25

Treatment problems for RA involving ocular?

Corticosteroids cause Glaucoma and cataracts
Hydroxychloroquin causes retinal pigment epithelial toxicity

26

Increase of sedimentation rate says what?

More inflammation

27

Rheumatoid factor only predictive n which patients?

Those with polyarthritis

28

Rheumatoid factor test best used in conjunction with what to up specificity to 98%?

Cyclic citrullinated peptide anitbodies ( anti-CCP)

29

Polymyalgia Rheumatica very responsive to what?

Corticosteroids

30

How do NSAIDS work?

Inhibition of COX in production of prostaglandin

31

How many forms of COX?

2

32

COX1 does what?

Constitutive functions (maintaining mucosal linking stomach, platelet function)

33

COX2 does what?

Mediation of pain and inflammation

34

Function of corticosteroids?

Inhibits synthesis of almost all Cytokines
Affects chemotaxis resulting in less inflamatory cells at site
Affects synthesis of COX2
Decrease circulating T cells

35

What does the DMARD Sulfasalazine do?

Inhibits production of various prostanoids
Results in reduction of circulating activated lymphocytes
Inhibition of B cell activation

36

How does Gold therapy work?

Numerous functions but importance of them is unknown

37

What does Gold therapy inhibit?

Acid phosphatase
Collagenase
Protein kinase C
Phospholipase C

38

What inhibits synthesis of purine nucleotides?

Methotrexate and azathioprine

39

What inhibits pyrimidine?

Leflunomide (Arava)