Podcast
Questions and Answers
What is the estimated annual economic cost of rheumatoid arthritis in the UK?
What is the estimated annual economic cost of rheumatoid arthritis in the UK?
What is the consequence of untreated inflammation in rheumatoid arthritis?
What is the consequence of untreated inflammation in rheumatoid arthritis?
Which cytokine is NOT typically associated with the inflammatory response in rheumatoid arthritis?
Which cytokine is NOT typically associated with the inflammatory response in rheumatoid arthritis?
Which auto-antibodies are commonly produced due to B cell activation in rheumatoid arthritis?
Which auto-antibodies are commonly produced due to B cell activation in rheumatoid arthritis?
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What percentage of patients are likely to become severely disabled due to rheumatoid arthritis?
What percentage of patients are likely to become severely disabled due to rheumatoid arthritis?
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What does a negative rheumatoid factor (RF) not exclude in a patient?
What does a negative rheumatoid factor (RF) not exclude in a patient?
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What is the average reduction in life expectancy for patients with rheumatoid arthritis?
What is the average reduction in life expectancy for patients with rheumatoid arthritis?
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Which of the following signaling pathways is activated in rheumatoid arthritis?
Which of the following signaling pathways is activated in rheumatoid arthritis?
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Which cell type primarily produces inflammatory cytokines in rheumatoid arthritis?
Which cell type primarily produces inflammatory cytokines in rheumatoid arthritis?
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What term describes the phase when rheumatoid factor levels may be low or absent in patients?
What term describes the phase when rheumatoid factor levels may be low or absent in patients?
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Which of the following best describes rheumatoid arthritis?
Which of the following best describes rheumatoid arthritis?
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Which joints are most commonly affected by rheumatoid arthritis?
Which joints are most commonly affected by rheumatoid arthritis?
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What is a hallmark symptom used to diagnose rheumatoid arthritis?
What is a hallmark symptom used to diagnose rheumatoid arthritis?
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What type of nodules are commonly associated with rheumatoid arthritis?
What type of nodules are commonly associated with rheumatoid arthritis?
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What percentage of the UK's population is estimated to be affected by rheumatoid arthritis?
What percentage of the UK's population is estimated to be affected by rheumatoid arthritis?
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Which of the following is NOT typically a non-articular feature of rheumatoid arthritis?
Which of the following is NOT typically a non-articular feature of rheumatoid arthritis?
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Which joint is least likely to be involved in rheumatoid arthritis?
Which joint is least likely to be involved in rheumatoid arthritis?
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What is a significant characteristic of the immune pathway in rheumatoid arthritis?
What is a significant characteristic of the immune pathway in rheumatoid arthritis?
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Which of the following statements about DMARDs is correct?
Which of the following statements about DMARDs is correct?
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At what age is the onset of rheumatoid arthritis typical but can occur much younger?
At what age is the onset of rheumatoid arthritis typical but can occur much younger?
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Study Notes
Rheumatoid Arthritis Lecture Notes
- Rheumatoid arthritis (RA) is a chronic autoimmune disease causing inflammation and destruction of joints.
- It's a systemic condition, meaning it affects the whole body.
- RA is characterized by inflammatory and destructive arthropathy in synovial joints (often hands, wrists, and feet).
- The disease cannot be cured.
Objectives
- Learn key terms related to rheumatoid arthritis.
- Understand RA's pathogenesis and immune response pathways.
- Identify potential drug targets for RA treatment.
- Summarize RA drug treatment approaches.
- Define Disease-Modifying Antirheumatic Drugs (DMARDs) and their mechanisms of action.
What is Rheumatoid Arthritis?
- RA is a common chronic autoimmune disorder.
- It causes an inflammatory response, leading to destructive joint changes.
- Synovial joints (hands, wrists, feet) are commonly affected.
- RA is a systemic condition that affects the whole body.
Normal Joint Structure
- Articular/hyaline cartilage acts as a shock absorber, reducing friction during joint movement.
- It is not innervated.
- Synovial membrane/synovium secretes synovial fluid that nourishes the cartilage and cushions the bones.
Pathophysiology of RA
- Articular pathophysiology involves inflammation within the joints.
- Non-articular pathophysiology involves inflammation in other parts of the body (eyes, heart, lungs).
Articular Symptoms of RA
- Joint pain, warmth, and swelling are typical.
- Three or more joints are frequently involved.
- Morning stiffness lasting more than 30 minutes is common.
Joints Commonly Affected by RA
- Metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of hands and metatarsophalangeal (MTP) joints in feet are frequently affected.
- Knees, ankles, and wrists are also commonly affected.
- Shoulders, elbows, acromioclavicular, and sternoclavicular joints can also be targets.
- Cervical spine can be affected with risk of spinal cord compression.
- Distal interphalangeal (DIP) joints are not generally affected.
Stages of RA
- Early stages and later stages show characteristic deformities including Boutonnière and Swan-neck deformities.
Non-articular Features of RA
- Rheumatoid nodules (firm bumps under the skin on arms) can be present.
- Inflammation can occur in other organs (eyes, lungs, heart). Anemia, fatigue, fever, tiredness are also common.
Impact of RA
- Mean age of onset is often later in life (40s-50s), but onset can occur earlier.
- Approximately (1%) of the UK population is affected.
- Severe disability can be a consequence of RA.
- Life expectancy can decrease by 3-18 years in severe cases.
- Significant financial costs (NHS and overall economic) are associated with RA.
Pathophysiology of RA
- Inflammation in the synovium, the lining of the joint, is key in RA development.
- This inflammation leads to the formation of pannus (thickened, inflamed tissue) that erodes cartilage and bone over time.
Signalling Pathways in RA
- Cytokines like IL-1, TNF-α, and IL-6 play a significant role in the inflammatory response.
- Activated immune cells (T cells, macrophages) are implicated.
- Metalloproteinases (e.g., collagenase) contribute to cartilage and bone damage.
Autoantibodies in RA
- Autoantibodies, such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (anti-CCP), are markers for RA in many cases.
- RF is sometimes negative in early RA, but the presence of anti-CCP is strongly indicative of RA.
Causes of RA
- Genetics and environmental factors are believed to be important.
Genetics
- Genetic predisposition is significant, with first-degree relatives showing a higher risk of developing RA compared to the control population.
Environment
- Suspects include smoking, hormones, infections, and geographical location.
- Diet is also potentially involved.
Diagnosis of RA
- Thorough physical examination.
- Blood tests (e.g., FBC, CRP, ESR, RF, anti-CCP).
- Imaging studies (X-rays, MRIs).
RA Drug Therapy
- DMARDs (eg. Sulfasalazine, penicillamine, gold compounds, chloroquine) and immunosuppressants (methotrexate) are involved in RA treatment to help to modify disease progression.
- Glucocorticoids (steroids) and targeted therapies (eg anti TNF and anti IL1) are also used.
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Description
Test your knowledge on rheumatoid arthritis, an autoimmune disease that primarily affects joints. This quiz covers key terms, pathogenesis, immune response pathways, and drug treatment approaches for managing RA. Learn about Disease-Modifying Antirheumatic Drugs (DMARDs) and their mechanisms of action.
