Term
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Definition
| Delayed hypersensitivity reaction. Autoimmune destruction - joint inflammation |
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Term
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Definition
= RHEUMATOID FACTOR
Produced by B cells
IGM against fc portion og IgG
Produced in normal people after rg EBV infection
IgM-IgG complexes attract neutrophils and fix complement
Not diagnostic - but good mnarker for monitoring of Rx |
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Term
| Describe the structure of the normal synocial membrane |
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Definition
SUBINTIMA CELLS
fatty/fibrous layer = support
INTIMA
T.1 = phagocytic
T.2 = HLA DR
T.3 = fibroblast like
secrete synovial fluid |
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Term
| Describe the pathology of RA |
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Definition
Small synovial joint swelling
symmetrical polyarthropathy
Chronic synovitis = neovascularisation and proliferation and hypertrophy of synovial cells = PANNUS
Infiltration of lymphos/macrophages and plasma cells into CT = rhem nodule
Boggy swelling |
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Term
| Describe the pathophysiology of RA |
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Definition
T cell activation
Inflammatory cytokines - TNF activate proteases
Attract and activate macrophages and B cells
Fibroblast/chondrocyte proliferation
Release of tissue destructive enzymes |
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Term
| What investigations would you do in RA? |
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Definition
Serology = RF
X Ray
Aspirate effusion
bloods= anaemia inc CRP/ESR
LFT's = inc alk phos and GGT |
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Term
| What are the XRAY features of RA? |
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Definition
loss of joint space
periarticular osteoarthritis
joint erosions
soft tissue swelling |
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Term
| What are the clinical features of RA? |
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Definition
Morning stiffness >1hr - releived by exercise
Soft tissue swelling
slow symmetrical polyarthropathy
fever/malaise
Hands+
- ulnar deviation of MCP
- radial deviation wrist
- boutonnieres
- swan neck
- z thumb
- palmar subluxation |
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Term
| What are the extra-articular manifestations of RA? |
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Definition
Lungs - effusions nodules fibrosis (PHT)
R.nodukes - subcut granuloma
Ruptured bakers cyst - DVT
Rh. ulcers - vasculitis
Haematological = ACD/ pernic anaemia dec folate
Neurologic = vasculitis of v.nervorum = polyneuropathy/mononeuritis multiplex
Eyes = scleromalacia/scleritis/sjrojens
Caridac= amyloidosis/pericarditis
Felty's LN's splenomegaly/leukopenia |
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Term
| What physical measures can be used in the management of RA? |
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Definition
advice/support for specialisty nurse
Physiotherapy - tens/hydro
OT = ADL's
Podiatry |
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Term
| What medication is used in the RX of RA? |
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Definition
NSAIDS/simple analgesiscs = bridge gap to DMARDS
DMARDS - inhib cytokines = dec inflammation = dec erosion |
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Term
| How does sulfasalazine work? Wat are its side effects? |
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Definition
Inhibitns TNF = decreased production of cytokines and ecosaniods
s/e = nausea vomitting headache rash
neutropenia/thrombocytopenia = mouth ulcers etc |
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Term
How does methotraxte work?
Side effects? |
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Definition
Anti-folate = inhibits DHFR = no THF
s/e oral mucositis/alopecia cannot use in preg or bfeeding |
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Term
What are the s/e of:- hydroxycholroquine
gold and cyclosporine? |
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Definition
H = renal/retinal toxicity
gold = apalastic anaemia/nephrotic syndrome
ciclosporine = hypertrichosis |
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Term
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Definition
| Monoclonal antibody against TNF a |
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Term
| What does etancercept do? |
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Definition
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