rheumatoid arthritis

Question 1

what is RA

Answer 1

chronic autoimmune disease causing pain in synovial joints

Question 2

features of RA

Answer 2

swelling of MULTIPLE joints (POLYARTHRITIS- NOT one joint) in hands/wrist= early morning stiffness it is SYMMETRICAL, affecting small joints can be systemic ie rheumatoid nodules produced under skin that can affect skin/other organs

Question 3

epi of RA- % pop and males vs females

Answer 3

1% pop affected, more females than males

Question 4

genetic component

Answer 4

HLA-DRB gene varians- produces shared epitope (certain a.a sequence)

Question 5

environmental component

Answer 5

smoking increases risk

Question 6

joints affected

Answer 6

MCP/MTPS, PIP, wrists and ankles

Question 7

DIAGRAM classic signs of RA

Answer 7

boutonniere deformity- permanent flexion at PIP swan neck deformity- permanent flexion at DIP

Question 8

differences between RA and OA

Answer 8

RA affects less older ppl, more middle age swelling is soft as affects synovium vs hard

Question 9

rheumatoid nodules- where occurs and affect

Answer 9

often occur near elbow and in hands- signs of more severe disease ie other organs affected

Question 10

diagnosis of RA

Answer 10

rheumatoid factor- IgM autoantibody against Fc part of IgG (antibody against antibody) antibodies to citrullinated protein antigens (more arginine converted to citrulline by PAD enzyme)

Question 11

extra-articular (systemic) features of RA

Answer 11

often fever/weight loss and nodules sometimes inflammation to vessels/eye, as well as lung disease

Question 12

xray of RA, early and later

Answer 12

initially osteopenia (thinning of bone= darker rather than fully white) then leads to bone erosion, and then deformity

Question 13

DIAGRAM pathogenesis of RA with main cytokine

Answer 13

abnormal synovial membrane due to inflammation- more blood vessels are recruited which carry more inflammatory cells and cytokines (mainly TNF ALPHA)

Question 14

biological therapies

Answer 14

TNFalpha inhibition by IV/subcutaneous antibodies can also inhibit IL6 aprt from cytokines, retuxinab given to inhibit B cells (CD20)

Question 15

treatment

Answer 15

treat EARLY and AGGRESSIVE use DMARDS (immune modulators), biological therapies and glucocorticoids

Question 16

problem with DMARD therapy and main drug

Answer 16

methotrexate don’t cure= potential remission

Question 17

problem with all anti-rheumatic drugs

Answer 17

increases infection risk

Question 18

problem with anti-TNF and retuxinab

Answer 18

can cause TB infection vs can cause Hep B infection