RHEUMATOLOGY REVIEW - short Flashcards Preview

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Flashcards in RHEUMATOLOGY REVIEW - short Deck (39):
1

Sports: in general, no increased risk; exercise may be _________ in OA

protective

2

Cartilage in early Osteoarthritis MMPS

Increased metalloproteinases

3

Osteoarthritis Factors

Interleukin-1
Nitric oxide
Prostaglandins
Complement activation
Adipokines

4

Rheumatoid Arthritis (RA)-- A systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a peripheral, ____________ which can result in cartilage and bone destruction

symmetric synovitis

5

Rheumatoid Arthritis-- Disease susceptibility and severity associated with shared epitope (QKRAA; in antigen binding groove) in subtypes of __________

HLA-DR4 and HLA-DR1;

6

Rheumatoid Arthritis-- RF-IgG immune complexes are _____________

pathogenic

7

____________: modulation and amplification of local immune response through antigen recognition (query altered proteoglycans or collagen; citrullinated peptides)

CD4+ memory T cells- Rheumatoid Arthritis

8

Gout-- The result of tissue deposition of monosodium urate (MSU) crystals due to hyperuricemia (MSU ___________ of extracellular fluids)

supersaturation

9

Hyperuricemia: over-production or under-excretion of uric acid; ______________ (90%)

underexcretors

10

Uric acid is a product of ___________ metabolism:

purine

11

Humans lack _________ which oxidizes uric acid into allantoin

uricase

12

Overproduction of uric acid (X-linked):
PRPP synthetase ___________
HGPRT deficiency (complete: Lesch-Nyhan)

overactivity

13

Crystal arthritis is diagnosed by arthrocentesis and crystal identification by polarized microscopy (MSU crystals: ______________)

needle-shaped, negatively birefringent

14

_________ promotes phagocytosis by PMNs
IgG: not specific anti-crystal antibodies
Apolipoprotein B-coating inhibits phagocytosis

IgG-coating

15

Overproduction of uric acid (X-linked):
PRPP synthetase overactivity
HGPRT __________ complete: Lesch-Nyhan)

deficiency

16

Crystal arthritis is diagnosed by ___________ and crystal identification by polarized microscopy (MSU crystals: needle-shaped, negatively birefringent)

arthrocentesis

17

IgG-coating promotes phagocytosis by PMNs
IgG: not specific anti-crystal antibodies
______________ inhibits phagocytosis

Apolipoprotein B-coating inhibits

18

Seronegative Spondyloarthropathies- Axial arthritis: spine, SI joints (__________); morning (am) stiffness

sacroiliitis

19

Seronegative Spondyloarthropathies
_______- ligamentous-, tendinous-, fibrous-osseous junctions

Enthesitis:

20

Seronegative Spondyloarthropathies Synovium: increased expression of_________

TNFalpha

HLA-B27 genetic association; neg RF and ANA

21

Chance of developing AS:
2% if HLA-B27 positive
20% if HLA-B27 positive with a ___________

first-degree relative with AS

22

Asymmetric, oligoarticular, lower ext arthritis

Reactive Arthritis- Bacterial environmental triggers transported to the joints inside monocytes (Chlamydia can be latent):

23

Systemic Lupus Erythematosus (SLE)- Fundamental defect is the _________________, resulting in an autoimmune process; T cell and B cell process

misdirected recognition of self as foreign

24

Systemic Lupus Erythematosus (SLE)- Antibody responses toward autoantigens are antigen-driven and ___________

require CD4+ T cells

25

Chance of developing AS:
2% if ____________
20% if HLA-B27 positive with a first-degree relative with AS

HLA-B27 positive

26

Loss of T cell tolerance permitting autoreactive B cell stimulation: ? central or ________________ abnormality in self-reactive lymphocyte deletion or anergy

peripheral

27

Systemic Lupus Erythematosus (SLE)- Association with HLA-DR3 and ___________ (greatest risk)

C4A null allele

28

Systemic Lupus Erythematosus (SLE)- Fundamental defect is the misdirected recognition of self as foreign, resulting in an autoimmune process; _________________

T cell AND B cell process

29

Loss of T cell tolerance permitting autoreactive B cell stimulation: ? central or peripheral abnormality in ____________ lymphocyte deletion or anergy

self-reactive

30

SLE: > 95% patients have + ANAs
Not specific for SLE: can occur in other CTDs
Antibodies are directed to _____________

multiple nuclear antigens

Anti-dsDNA antibodies: renal disease
Anti-histone antibodies: SLE and drug-induced lupus
Antibodies to non-DNA, non-histone nuclear antigens:

31

SLE- Anti-phospholipid antibodies: block prothrombin activation in the clotting cascade; associated with increased ___________;

clotting

32

Vasculitis: Immune complexes: inflamm→ PAFs→ ↑vascular permeability→ IC deposition; ___________

palpable purpura

33

Cytoplasmic ANCA (c-ANCA):

Proteinase-3 (PR3) in primary granules of PMNs
Associated with generalized GPA (Wegener’s)

34

Perinuclear ANCA (p-ANCA):

Myeloperoxidase (MPO) in primary granules of PMNs
Associated with microscopic polyangiitis (MPA)

35

ANCA Vasculitis

Antineutrophil Cytoplasmic Antibodies (ANCAs):

36

Vasculitis: Immune complexes: inflamm→ PAFs→ ↑____________→ IC deposition; palpable purpura

vascular permeability

37

Anti-synthetase Syndrome

PM or DM presenting with:
Interstitial lung disease (ILD): 60%

Anti-Jo-1 = anti-histadyl-tRNA synthetase
Not pathologic or myotoxic antibodies

38

Endomysial distribution of inflammatory cells (CD8+ T cells) surrounding and invading muscle fibers

Polymyositis

39

Perivascular (CD4+ T cells) and perifascicular inflammatory infiltrate

Dermatomyositis