Rheumatoid Arthritis Complications Quiz

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Questions and Answers

What is the primary hallmark of Rheumatoid Arthritis?

Cyst formation in tissues

Calcification of joint cartilage

Bony outgrowths in joints

Synovial inflammation (correct)

Which of the following cells are primarily involved in the inflammatory response in established Rheumatoid Arthritis?

T cells and Neutrophiles (correct)

Fibroblasts and Osteoblasts

Eosinophils and Basophils

Chondrocytes and Adipocytes

What role does IL-6 play in the context of Rheumatoid Arthritis?

It inhibits synovial cell proliferation

It exacerbates bone destruction

It acts as a differentiation factor for B-cells (correct)

It decreases macrophage activity

Which cytokine is implicated in activating macrophages in Rheumatoid Arthritis?

TNF-a Signup and view all the answers

Which systemic involvement is commonly associated with Rheumatoid Arthritis?

Osteoporosis development Signup and view all the answers

What is the main type of joint damage seen radiographically in Rheumatoid Arthritis?

Joint space narrowing Signup and view all the answers

What type of infiltrate characterizes the synovial tissue in established Rheumatoid Arthritis?

Heterogeneous inflammatory cells Signup and view all the answers

Which of these cells is NOT typically found in the inflammatory infiltrate of Rheumatoid Arthritis?

Red blood cells Signup and view all the answers

Which symptom is part of the 1987 revised ARA criteria for rheumatoid arthritis?

Hand joint arthritis in at least one of wrist, MCP or PIP joints Signup and view all the answers

What are common radiographic changes associated with very late rheumatoid arthritis?

Osseous ankylosis of wrist joints Signup and view all the answers

Which systemic involvement is frequently associated with rheumatoid arthritis?

Keratoconjunctivitis sicca Signup and view all the answers

Which of the following statements about subcutaneous nodules in rheumatoid arthritis is correct?

They are often associated with disease activity. Signup and view all the answers

Which laboratory finding is typically elevated in rheumatoid arthritis?

Elevated SGOT and ALP Signup and view all the answers

Which radiographic change is seen in the early stage of rheumatoid arthritis?

Loss of joint space Signup and view all the answers

What is a well-known complication of long-lasting rheumatoid arthritis?

Amiloidosis Signup and view all the answers

What is a common ocular manifestation associated with rheumatoid arthritis?

Cataract Signup and view all the answers

What laboratory finding is commonly seen in vasculitic patients?

Low serum complement Signup and view all the answers

Which of the following is NOT a cause of anemia associated with rheumatoid arthritis?

Increased erythropoietin production Signup and view all the answers

What is characteristic of Felty syndrome?

Association with long-lasting, seropositive RA Signup and view all the answers

Which systemic involvement is frequently found in patients with rheumatoid arthritis?

Pulmonary involvement Signup and view all the answers

In patients with ongoing chronic inflammation related to anemia, which factor contributes to ineffective erythropoiesis?

Enhanced iron retention in the reticuloendothelial system Signup and view all the answers

What is the most common cardiac involvement in rheumatoid arthritis?

Pericarditis Signup and view all the answers

What is a common complication of rheumatoid arthritis related to granulocyte activity?

Increased granulocyte segmentation Signup and view all the answers

Cryoglobulinemia in vasculitis is often associated with which laboratory finding?

High rheumatoid factor Signup and view all the answers

Study Notes

Vasculitis in RA

Vasculitis can occur in RA patients and is frequently seen in long-lasting, seropositive RA patients after 10 years
Elevated rheumatoid factor (RF) and low serum complement levels are common in vasculitis
Cryoglobulins, circulating immune complexes, high erythrocyte sedimentation rate (ESR), thrombocytosis, anemia, and low serum albumin can also be associated with RA-related vasculitis

Anemia in RA

Anemia often accompanies RA and is linked to the severity of inflammation
It is associated with decreased hemoglobin synthesis
Erythropoietin levels may be decreased, leading to an ineffective response of bone marrow to erythropoietin
Iron replacement may be insufficient due to decreased iron utilization and increased lactoferrin levels that bind iron
Primary destruction of red blood cells (RBC) and inhibition of production of RBC precursors also contribute to anemia in RA

Felty Syndrome

Felty syndrome is the association of rheumatoid arthritis (RA), splenomegaly, and leukopenia
It is often seen in long-lasting, seropositive, nodular, and deforming RA
Patients with Felty syndrome may have low leukocyte counts, increasing their susceptibility to bacterial infections
Hypocomplementemia and increased immune complex levels are features of Felty Syndrome
These immune complexes attack granulocytes, leading to increased granulocyte segmentation and decreased granulocyte lifespan
Patients with Felty syndrome may experience low leukocyte counts due to specific bacterial infections and an inadequate response of the bone marrow
Effective disease-modifying antirheumatic drugs (DMARD) treatment can reduce the risk of infection in Felty syndrome
Splenectomy is generally an effective treatment for Felty Syndrome

Systemic Involvement in RA

Pulmonary involvement: Frequent, found in 50% of RA patients at autopsy
Caplan's syndrome: Pulmonary nodulosis + pneumoconiosis, characterized by multiple peripheral lung nodules > 1 cm, often seen in individuals exposed to silica, coal dust, etc.
Cardiac involvement: Pericarditis is the most frequent, rarely symptomatic
Muscular involvement: Muscle atrophy is associated with inflammation
Renal involvement: Seldom, often due to drug side effects, includes mesangial glomerulonephritis and amyloidosis
Ocular involvement: Keratokonjunctivitis sicca (dry eye), episcleritis, cataracts (associated with glucocorticoids), glaucoma (associated with glucocorticoids), retinopathy (chloroquine)

Rheumatoid Arthritis (RA)

A chronic, progressive, and systemic autoimmune inflammatory disease primarily affecting joints
Inflammation of the synovial joints (synovitis) is a hallmark of RA
B lymphocytes play multiple roles in RA, including cytokine production, antigen presentation, T-cell response modulation, and antibody production.

Rheumatoid Inflammation

The synovium lining the joint capsule is a thin membrane derived from embryonic mesenchyme
In RA, chronic and clinically significant synovial inflammation develops, ultimately leading to cartilage and bone destruction
The inflammatory synovial infiltrate in established RA is diverse and includes T cells (CD4+ > CD8+), T regulatory cells, Th17 cells, B cells, plasma cells, macrophages, dendritic cells, mast cells, natural killer cells (NK), and neutrophils
Adhesive molecules, such as ICAM-1 and ICAM-3, are elevated in RA, contributing to inflammation

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Description

Test your knowledge on complications associated with rheumatoid arthritis, including vasculitis, anemia, and Felty syndrome. This quiz explores the clinical features and laboratory findings related to these conditions. Perfect for students and professionals in medicine and healthcare.