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59 Cards in this Set
- Front
- Back
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how is viscosity of synovial fluid related to load?
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viscosity increases with load
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what within synovial joints resists shearing forces?
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irregular junction between cartilage and subchondral bone
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why is articular cartilage a good shock absorber?
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matrix containing hydrophilic glycosaminoglycans (GAGs) trapped in an inextensible collagen fibril framework
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what is the initiating event of synovitis?
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activation of CD4 T cells by (unknown) antigen in immunogenetically susceptible hosts
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what cells accompany T cells infiltrating the synovium?
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mast cells, neutrophils, mononuclear phagocytes that rapidly mature to activated macrophages
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which antibodies are present in the earliest stages of disease in almost 70% of rheumatoid patients?
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anti-CCP antibodies
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what is rheumatoid factor?
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immunoglobulins (autoantibodies) mostly of IgM class that are reactive agaist epitopes on the Fc portion of native IgG
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what are the most active cells found in the synovium in RA?
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macrophages
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what are the macrophage derived cytokines present in the synovium in RA?
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IL-1, IL-6, IL-8, TNF-alpha, GM-CSF
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t/f... high levels of IL-2, IL-4 and IFN-gamma are detected in the synovium in RA?
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false, low levels of these t cell derived cytokines are found
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what is responsible for activation of adhesion molecules on blood vessels in RA?
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pro-inflammatory cytokines
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which cytokines are involved in the development and perpetuation of synovitis?
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GM-CSF, IL-2, IL-15, IL-13, IL-17, IL-18, IFN-gamma, TNF-alpha, TGF-beta
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what does IL-15 do?
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induces TNF-alpha production by macrophages
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which cytokine induces TNF-alpha production by macrophages?
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IL-15
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which cytokine sustains the Th 1 phenotype?
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IL-18
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what induces and stabilises new capillary formation?
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hypoxia inducible factor-1 (a transcription factor)
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which cells produce large quantities of proteolytic enzymes?
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activated macrophages, neutrophils and fibroblasts
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how are metalloproteinases activated?
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by partial splitting by other proteases, trypsin, plasma or tryptase
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what is the primary susceptibility haplotype for RA?
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HLA-DR4
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what causes destruction of articular cartilage and bone in RA?
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progression of pannus
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in what percentage of cases of RA will rheumatoid nodules be seen?
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25%
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where are rheumatoid nodules most commonly seen?
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elbows and ulnar aspect of forearm
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which conditions are associated with HLA B27?
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spondyloarthropathies (including ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome, enteropathic arthritis)
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which joints are commmonly affected by RA?
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PIPs, MCPs, wrist, ankle, MTPs
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what are Heberden's nodes?
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bony swellings observed in OA of DIPs
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which deformity is characterised by flexion of DIP/MCP and hyperextension of PIP?
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swan-neck deformity
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what is a boutonniere deformity?
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flexion of PIP and hyperextension of DIP
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what is the name given to a bony spur forming on the PIP?
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bouchard's node
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what type of anaemia do patients with RA have?
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normocytic, normochromic
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t/f... platelet dysfunction accompanies the thrombocytosis associated with RA
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false, while thrombocytosis may occur in active disease, the platelet function is normal
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which type of vasculitis associated with RA will produce a palpable purpura?
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leukocytoclastic vasculitis
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what is the most common cardiac manifestation of RA?
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pericarditis
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what is Felty's syndrome?
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RA, splenomegaly and neutropenia
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what is tolerance?
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specific inability of the immune system not to respond to self antigens
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what is positive selection?
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recognition of self HLA molecules (failure leads to cell death)
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what is negative selection?
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recognition of self peptide/HLA (leads to cell death by apoptosis)
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which cell markers are required for costimulation?
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CD28-CD80,86
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what controls expansion of T cells?
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Fas-FasL
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which HLA allele is assicated with RA?
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DR4
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what converts phospholipid into arachidonic acid?
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phospholipase A2
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which enzyme converts arachidonic acid to prostoglandins?
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cyclooxygenase
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which enzyme converts arachidonic acid to leukotrienes?
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lipoxygenase
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which prostaglandins are vasodilators?
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PGE2 and PGI2
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what is the mechanism of action of NSAIDs?
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inhibits cyclo-oxygenase
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what are the side effects of NSAIDs?
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dyspepsia, gastritis, peptic ulceration, reduced platelet aggregation, renal impairment, aggravate asthma (in 5% asthmatics), skin rashes
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what prostanoids are produced by COX-2?
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prostanoids that mediate inflammation, pain and fever
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which isoform of COX is constitutively expressed?
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COX-1
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where is COX-2 induced?
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sites of inflammation
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where is COX-2 constitutively expressed?
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brain, kidney
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in what situations are COX-2 inhibitors used?
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if NSAIDs not tolerated or contra-indicated
patients with high CV risk |
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what are the short term side effects of corticosteroids?
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weight gain, mood changes, increased blood glucose, hypokalaemia, transitory HPA axis suppression
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which type of synoviocyte is macrophage-like?
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Type A synoviocyte
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which type of synoviocyte is fibroblast-like?
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Type B
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where is COX-2 constitutively expressed?
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brain, kidney
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in what situations are COX-2 inhibitors used?
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if NSAIDs not tolerated or contra-indicated
patients without high CV risk |
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what are the short term side effects of corticosteroids?
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weight gain, mood changes, increased blood glucose, hypokalaemia, transitory HPA axis suppression
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which type of synoviocyte is macrophage like?
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Type A synoviocyte
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which type of synoviocyte is fibroblast-like?
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Type B
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what are some xray changes in RA?
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joint narrowing, erosions adjacent to cartilage, osteopenia
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