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Questions and Answers
What is the sensitivity of ELISA kits for anti-CCP antibodies in diagnosing rheumatoid arthritis (RA)?
Which of the following joints is NOT typically affected by symmetric polyarticular arthritis in RA?
Which characteristic is observed in synovial fluid during inflammation in RA?
What does the term 'pannus' refer to in the context of rheumatoid arthritis?
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What percentage of patients with rheumatoid arthritis are likely to develop subcutaneous nodules?
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What effect does increased osteoclast activity have in rheumatoid arthritis?
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Which cells are primarily involved in the expansion of the synovium during inflammation in RA?
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Which statement about anti-cyclic citrullinated protein (CCP) antibodies is accurate?
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What symptom is commonly associated with Ankylosing Spondylitis?
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Which of the following conditions is most likely associated with HLA-B27?
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What is a characteristic feature of psoriatic arthritis?
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How does reactive arthritis typically present in men aged 20-30?
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When do symptoms of psoriatic arthritis usually manifest?
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What distinguishes the clinical course of ankylosing spondylitis?
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Which symptom is considered a component of the classic triad in reactive arthritis?
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What type of joint involvement is characteristic of reactive arthritis?
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Which type of juvenile idiopathic arthritis affects less than five joints?
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What is a significant complication of juvenile idiopathic arthritis that can lead to micrognathia?
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What percentage of adults with juvenile idiopathic arthritis have been found to show TMJ abnormalities?
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What is the primary cause of gout?
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What is essential but not sufficient for the development of gout?
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In ankylosing spondylitis, which pathogen is associated with the inflammation process through molecular mimicry?
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Which characteristic is NOT commonly associated with chronic idiopathic arthritis?
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Which finding is NOT associated with systemic juvenile idiopathic arthritis?
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Study Notes
Rheumatoid Arthritis (RA)
- Higher levels of anti-cyclic citrullinated protein (CCP) antibodies indicate a greater chance of destructive joint disease.
- During inflammation, arginine residues in proteins can be converted into citrulline.
- CCP antibodies target these citrullinated proteins.
- ELISA kits for anti-CCP have a sensitivity of up to 77.5% and specificity of up to 96.4% for RA.
- RA is characterized by symmetric polyarticular arthritis, affecting small joints including: hands, feet, ankles, wrists, elbows, shoulders.
- Synovial hyperplasia occurs with RA resulting in:
- Increased synovial fluid production.
- Decreased synovial fluid viscosity.
- Leukocytes infiltrate and expand the synovium, causing inflammation. This influx of immune cells increases vascularity and leads to a hyperplastic synovial membrane.
- Neutrophils are increased in the synovial fluid.
- Increased osteoclast activity leads to bone resorption.
RA Pannus Formation
- RA pannus is a destructive fibrovascular tissue composed of fibroblasts and leukocytes, which invades surrounding structures, including bone, cartilage, and tendons.
- This invasion is accompanied by destruction of articular cartilage and subarticular bone.
Rheumatoid Nodules
- Rheumatoid nodules are firm lumps found under the skin, often near affected joints.
- They occur in approximately 20-25% of patients with RA.
Ankylosing Spondylitis
- Ankylosing spondylitis (AS) features insidious onset of low back pain usually starting before the age of 40.
- Symptoms worsen in the morning or with inactivity, and improve with exercise.
Reactive Arthritis (ReA)
- ReA is an autoimmune condition that develops following an infection.
- Infections associated with ReA include:
- Non-gonococcal genitourinary (GU) infections resulting in urethritis or cervicitis.
- Gastrointestinal (GI) infections caused by Shigella, Salmonella, or Campylobacter bacteria.
- While infections occur in specific areas, ReA can impact other parts of the body.
- ReA typically affects men between 20-30 years old.
- Genetic predisposition is linked to HLA-B27.
- The classic triad of ReA symptoms, found in about one-third of patients includes:
- Noninfectious urethritis
- Conjunctivitis
- Arthritis
- Arthritis develops weeks after urethritis and is typically asymmetric.
- Commonly affects ankles, knees, or feet.
- Chronic ReA can resemble Ankylosing Spondylitis.
Psoriatic Arthritis
- Psoriatic arthritis is associated with psoriasis.
- It usually develops 10 years after the onset of psoriasis, affecting around 10% of patients.
- People in their 30s to 50s are more likely to develop psoriatic arthritis.
- Genetic predisposition is associated with HLA genes.
Psoriatic Arthritis Symptoms
- Psoriatic arthritis symptoms include:
- Joint pain
- Stiffness
- Swelling
- Relapsing remitting course
- It affects peripheral and axial joints.
- A characteristic presentation includes sausage-like fingers.
Juvenile Idiopathic Arthritis (JIA)
- JIA is a heterogeneous group of disorders with various types:
- Polyarticular: Five or more joints involved.
- Pauciarticular (Oligoarthritis): Less than five joints involved.
- Systemic: Arthritis in one or more joints plus fever for at least two weeks, accompanied by features such as: erythematous rash, hepatomegaly or splenomegaly, lymph node enlargement, or serositis.
- Temporomandibular joint (TMJ) involvement can occur in JIA.
- TMJ involvement can lead to micrognathia, where the lower jaw is smaller.
- Predictors of radiographic TMJ damage include pain with TMJ movement and limited jaw opening.
- TMJ involvement progresses slowly, making changes subtle.
- TMJ abnormalities have been found in 70% of adults with JIA.
Gout
- Gout is caused by tissue accumulation of uric acid (urate).
- It is characterized by recurrent episodes of acute arthritis.
- Men typically develop gout in their 40s or later, while women develop it after menopause.
Gout Pathogenesis
- Uric acid is the end product of purine metabolism.
- Hyperuricemia, high levels of uric acid in the blood, is required for gout development, but not sufficient on its own.
- Over 10% of people in the Western hemisphere have hyperuricemia, but only a small percentage develop gout.
- 90% of gout patients are HLA-B27 positive.
Ankylosing Spondylitis and Molecular Mimicry
- Ankylosing spondylitis is associated with the presence of antibodies against antigens from Klebsiella bacteria.
- Molecular mimicry is the mechanism behind this phenomenon.
- The immune system targets Klebsiella antigens, triggering an inflammatory response.
- Antibodies against Klebsiella cross-react with antigens found in the spine, contributing to joint inflammation characteristic of Ankylosing Spondylitis.
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