SM_234a: Rheumatoid Arthritis Flashcards Preview

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Flashcards in SM_234a: Rheumatoid Arthritis Deck (45)
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1

Rheumatoid arthritis is _____

Rheumatoid arthritis is a chronic inflammatory joint disease of autoimmune nature characterized by the development of autoantibodies

 

(more common in women, occurs earlier in women)

2

Risk factors for RA include ____, ____, ____, ____, ____, and ____

Risk factors for RA include genetic, epigenetic, female sex, smoking, dust inhalation, and microbiota (periodontal disease, gut microbiome)

3

Shared epitope is a ______

Shared epitope is a specific amino acid motif commonly encoded by alleles of the HLA-DR loci that confers genetic susceptibility to development of RA

 

(specific class II HLA antigen loci show strong association with RA, HLA-DRB1*01 and HLDRB1*04 are among strongest risk factors, many loci harbor RA susceptibility variants of variable strength)

4

Locus involves in RA is _____

Locus involves in RA is HLA DR

5

Environmental risk factors for RA are ____, ____, and ____

Environmental risk factors for RA are smoking, dust inhalation, and microbiota

 

  • Risk from smoking increases in a graded fashion
  • Dust inhalation
  • Periodontal disease increases risk of developing RA
  • Gut microbiome changes in RA

6

Healthy synovium has ____ and has a sublining of ____, ____, ____, and ____

Healthy synovium has an intimal lining of macrophage-like and fibroblast-like synoviocytes and sublining of fibroblasts, adipocytes, blood vessels, and immune cells

 

  • Intimal lining is a delicate and leaky and allows free movement of cells and proteins into synovial fluid

7

Healthy synovium functions to _____ and _____ during homeostasis

Healthy synovium functions to produce lubricants for cartilage and provide nutrients to cartilage during homeostasis

8

In RA, pathological changes of the synovium include ____, ____, ____, and ____

In RA, pathological changes of the synovium include expansion of intimal lining with activated synoviocytes producing pro-inflammatory cytokines, infiltration of adaptive immiune cells into synovial sublining with hypervascularity, formation of a pannus, and activation of osteoclasts to degrade bone

9

Pannus is an _____

Pannus is an invasive destructive front of synovial tissue attached to the articular surface

10

Describe pathological changes in the RA synovium

RA synovium pathological changes

  • Intimal lining greatly expands with activated synoviocytes producing pro-inflammatory cytokines
  • Infiltration of adaptive immune cells into synovial sublining with hypervascularity
  • Pannus: invasive, destructive front of synovial tissue attached to the articular surface
  • Activated osteoclasts degrade bone

11

Pannus is  formed by ____, ____, and ____

Pannus is formed by the expansion of activated synoviocytes, infiltration of immune cells, and hypervascularity

12

Describe the disease coure of RA

RA disease course

  • Pre-clinical: citrullination
  • Early: synovitis
  • Established: joint damage

13

Pre-clinical RA is characterized by _____

Pre-clinical RA is characterized by citrullination

14

Early RA is characterized by _____

Early RA is characteirzed by synovitis

15

Established RA is characterized by _____

Established RA is characterized by joint damage

16

Describe the disease course and pathogenesis of RA

RA disease course and pathogenesis

  • Pre-clinical RA: circulating autoantibodies and pro-inflammatory cytokines are detectable up to 10 years before clinical disease onset
  • Citrullination is a key step in RA pathogenesis that leads to immune activation and production of RF and ACPAs
  • Synovitis and joint damage are cardinal features of RA driven by pro-inflammatory cytokines IL-1, IL-6, and TNF

17

Describe the HPI of someone with RA and someone with OA

  • RA: usually insidious onset of symmetric polyarthritis (>3 joints) especially in joints of hands and feet, joint swelling, decreased ROM in joints, pain and swelling worse in morning, morning stiffness lasting >1 hour, stiffness after rest (gelling)
  • OA: insidious, bony enlargement of joints, morning stiffness lasting < 30=60 minutes, stiffness after rest (gelling)

18

RA involves joint _____, while OA involves _____ of joints

RA involves joint swelling, while OA involves bony enlargement of joints

19

Morning stiffness lasts ____ in RA than OA

Morning stiffness lasts longer in RA than OA

20

Describe joints involved in RA

Joints involved in RA

  • Hands: metacarpophalangeal joints (MCPs), proximal interphalangeal joints (PIPs), wrists, elbows, shoulders, hips, knees, ankles, metatarsophalangeal joints (MTPs), and cervical spine

 

 

(OA involves the DIPs, does not involve MCPs or ankle, and only involves 1st MTP)

21

Physical exam findings in early RA include ____ and ____

Physical exam findings in early RA include symmetric joint swelling / tenderness and palpable swelling / synovial boginess

 

 

 

(in OA there is joint enlargement due to bony hypertrophy in osteoarthritis)

22

Physical exam findings in advanced RA include _____, _____, and _____

Physical exam findings in advanced RA include joint deformity / malalignment, limited ROM, and rheumatoid nodules at pressure points

 

 

(MCP joint ulnar deviation and subluxation)

23

Swan neck deformity in RA is _____

Swan neck deformity in RA is flexion at DIP and hyperextension at PIP

24

Boutonniere deformity in RA is _____

Boutonniere deformity in RA is flexion at PIP and hyperextension of DIP

25

_____ and _____ distinguish RA from OA in the hands

Prolonged morning stiffness and sparing of DIP joints distinguish rheumatoid arthritis from OA in the hands

26

RA patients are at high risk for premature _____

RA patients are at high risk for premature cardiovascular disease

27

Describe radiographic changes in RA

Radiographic changes in RA

  • Soft tissue swelling 
  • Periarticular osteopenia
  • Uniform / symmetric joint space loss
  • Marginal erosions
  • Symmetric deformities (swan neck, boutonniere, ulnar deviation, subluxation)

28

Describe late RA changes in the hands

Late RA changes in the hands

  • Diffuse joint space narrowing
  • MCP subluxation and ulnar deviation
  • Demineralization
  • Marginal erosions at MCPs 
  • Carpal joint space narrowing and erosions

29

____ may occur in RA due to instability resulting from synovitis of the atlantoaxial joint

Atlantoaxial subluxation may occur in RA due to instability resulting from synovitis of the atlantoaxial joint

30

____, ____, and ____ are characteristic X-ray findings in RA

Soft tissue swelling, periarticular osteopenia, and marginal erosions are characteristic X-ray findings in RA

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