Rheumatoid Arthritis Flashcards Preview

Y2 LCRS 2 - Musculoskeletal - Laz > Rheumatoid Arthritis > Flashcards

Flashcards in Rheumatoid Arthritis Deck (41)
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1

Define Rheumatoid Arthritis

Chronic autoimmune disease characterised by pain, stiffness and SYMMETIRCAL SYNOVITIS of synovial (diarthrial) joints

2

When is the stiffness in the joints particularly bad in rheumatoid arthritis and what can make it better?

In the morning
It gets better with exercise

3

What is a relatively common extra-articular manifestation of rheumatoid arthritis?

Rheumatoid nodules

4

What causes the extra-articular manifestations?

Rheumatoid factor produces immune complexes that can go anywhere

5

What type of antibody is the rheumatoid factor?

IgM antibody that binds to the Fc portion of IgG

6

Is rheumatoid arthritis more common in males or females?

More common in females (3:1)

7

What is the important genetic component that predisposes toRheumatoid Arthritis?

The genetic component comes down to a specific set of amino acids within the beta chain of the DR molecule (amino acids 70-74 of the DR Beta1-chain)
This set of amino acids is conserved among all HLA subtypes that are associated with rheumatoid arthritis – it is called the shared epitope

8

What important environmental factor can affect the susceptibility and severity of Rheumatoid Arthritis?

Smoking

9

State some joints that are commonly affected in Rheumatoid Arthritis.

Metacarpophalangeal joint (MCP)
Proximal interphalangeal joint (PIP)
Wrists
Knees
Ankles
Metatarsophalangeal joint (MTP)

10

Name and describe two deformities that are indicative of Rheumatoid Arthritis.

Swan-neck deformity
 Hyperextension of PIP
 Hyperflexion of DIP
Boutonniere deformity (button-like)
 Hyperflexion at PIP

11

What is the term given to fingers that are completely swollen, notjust around the joints?

Dactylitis – this can’t be explained by Rheumatoid Arthritis because it is not just the joints that are inflame

12

Describe the appearance of extensor tenosynovitis.

There will be swelling around the extensor tendon that is inflamed
When the fingers are extended, the swelling will move showing that the inflammation is around the tendon and not the joint

13

Other that joints and around tendons, where else can synovium become inflamed?

Bursae --> Bursitis

14

What are sub-cutaneous nodules?

Central area of fibrinoid necrosis surrounded by histiocytes and a peripheral layer of connective tissue

15

Why are rheumatoid nodules an important clinical finding?

Patients with rheumatoid nodules are always rheumatoid factor positive

16

Where are rheumatoid nodules commonly seen?

Along the ulnar border

17

What proportion of cases of Rheumatoid Arthritis is rheumatoid factor negative?

1/3

18

Name another autoantibody that is very specific for Rheumatoid Arthritis.

Anti-cyclic citrullinated peptide antibody

19

Which enzymes are responsible for the citrullination of peptides?

Peptidyl arginine deaminases (PADs

20

Why do citrullinated peptide antigens develop in rheumatoid arthritis?

PADs are present in high concentrations in neutrophils and monocytes so there is increased citrullination of autologous peptides in inflamed synovium
Citrulline binds much better than arginine to the shared epitope (specific peptide sequence that is conserved in all MHC molecules that are associated with Rheumatoid Arthritis)
So Anti-CCP antibodies are more likely to develop in individuals with citrullinated autoantigens and those that have the shared epitope

21

State some common extra-articular manifestations of Rheumatoid Arthritis.

Rheumatoid nodules
Fever
Weight loss

22

State some rare extra-articular manifestations of Rheumatoid Arthritis.

Vasculitis
Episcleritis
Neuropathies
Amyloidosis
Lung disease (nodules, fibrosis, pleuritis)
Felty’s syndrome (triad of splenomegaly, leukopenia and rheumatoid arthritis)

23

What is an early radiographic abnormality in Rheumatoid Arthritis?

Juxta-articular osteopenia

24

What are some later radiographic abnormalities in Rheumatoid Arthritis?

Joint erosion and, subsequently, joint destruction and deformity

25

What is the name given to the thickened, chronically inflamed synovial tissue in Rheumatoid Arthritis?

Pannus

26

Which area of bone tends to be eroded first in Rheumatoid Arthritis?

Bare area of bone – this is within the synovial membrane but is not covered by articular cartilage (periarticular erosion)

27

How thick is the normal synovial membrane?

It is normally almost a single cell lining

28

Which cells are responsible for producing synovial fluid?

Synovial fibroblasts
NOTE: macrophages are also found within the lining

29

Why is synovial fluid viscous?

It contains hyaluronic acid

30

What type of collagen is present in articular cartilage?

Type 2 collagen