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19 Cards in this Set

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What does pannus consist of?
Hypertrophied synovium – fibrocellular mass of synovium consisting of inflammatory cells, granulation tissue and fibroblasts
Where does pannus first develop?
In areas where there is a double reflection of synovium
What are pocket erosions?
Erosions that occur at the cartilage margins and juxta-articular margins in the subchondral bone.
What is the pathogenesis of RA? (overview)
Trigger unknown. APC activates T Cells (2nd signal required) leading to; 1) B-cell activation → immune complex formation, 2) activation of monocytes, macrophage & synovial fibroblasts → IL-1, IL-6, TNF-α release and angiogenesis, 3) ↑ osteoclast activity. Synovium becomes inflamed, inflammation continues, synovium forms pannus on cartilage → cartilage and bone erosion → loss of joint integrity → surrounding muscles, lig and tendons become weak → bone subluxation.
What is the main inflammatory mediator?
TNF-α
What does IL-1 do when activated?
Recruitment of neutrophils, leads to release of protease and elastase → degradation of peptidoglycan of cartilage
What action does TNF-α have when activated?
Promotes inflammation++, also directly causes ↑ release of IL-1 and activates more macrophages
What action does IL-6 have when activated?
Proliferation of synovial fibroblasts → 1) pannus formation and invasion of cartilage, and 2) release of matrix metalloproteinases
- Both lead to cartilage and bone destruction
Why is osteopenia seen with RA?
Activated T Cell activates osteoclast formation via RANKL expression. ↑ Bone resorption occurs, with ↑ in MMP released.
Bone destruction
What is the significance of angiogenesis in RA?
Leads to accumulation of B and T Cells in synovium → release of inflammatory mediators
What happens with B Cell activation?
Leads to autoantibody (IgG) production including RF. Activation of complement cascade → accumulation of PMNs; inflammatory symptoms
Are osteophytes seen with RA?
Usually NO
What are the radiographic hallmarks of RA?
1) Joint effusions
2) Juxta-articular osteopenia
3) Erosion and narrowing of the joint space with loss of articular cartilage
4) Subchondral cysts
5) Large synovial cysts (↑ intra-articular pressure → outpouching of synovium)
What are some pathologic changes of joint and complications of chronic synovitis in RA?
1) Joint deformities (swan neck, boutonnierre, ulnar deviation of MCP, radial deviation of wrist, hammer toes, mallet toe, claw toes, flexion contracture)
2) Atlanto-axial subluxation → neuro impingement
3) ↓ shd mobility and ROM, dislocation, tears of rotator cuff → chronic spasm
4) Carpal tunnel
5) Ruptured bakers cyst
6) Anemia of chronic disease
7) ↓ Functional capacity and early mortality
What are the most commonly affected joints in RA?
PIP, MCP, wrist (but not 1st CMC), elbow, shd, knee, ankle, MTP, C-spine
T cells in RA have a defect in _______
Apoptosis
What is a boutonniere deformity?
Hyperextension of the DIP joint and flexion in the PIP joint.
What is a swan-neck deformity?
Hyperextension of the PIP joint and flexion of the DIP joint
What is the Terry Thomas Sign?
Widened space between the carpal lunate and scaphoid bone