Rheumatoid Arthritis Overview
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Questions and Answers

Which of the following statements about erosion in rheumatoid arthritis (RA) is true?

  • Both joint pain and erosion are reversible.
  • Erosion is not detectable on an X-ray.
  • Erosion occurs due to the pannus. (correct)
  • Erosion can be reversed with medication.

    • Early treatment of rheumatoid arthritis can prevent disability.

    True

    What are the two main deformities associated with early RA?

    Boutonnière deformity and Swan neck deformity.

    The rapid progression of erosion in rheumatoid arthritis can lead to _____ in daily activities.

    <p>disability</p> Signup and view all the answers

    Match the extra-articular manifestations with their descriptions:

    <p>Vasculitis = Expression of a vascular process leading to skin nodules Amyloidosis = Abnormal protein buildup Interstitial lung disease = Pulmonary fibrosis detected by Velcro sound Serositis = Inflammation of serous tissue</p> Signup and view all the answers

    What is the primary reason for the early treatment of rheumatoid arthritis?

    <p>To prevent the occurrence of bony erosions.</p> Signup and view all the answers

    Morning stiffness is one of the common early symptoms of rheumatoid arthritis.

    <p>True</p> Signup and view all the answers

    What type of medication is initially used to manage pain in RA?

    <p>Paracetamol and NSAIDs.</p> Signup and view all the answers

    What is the primary factor responsible for bone erosion in rheumatoid arthritis?

    <p>Pannus</p> Signup and view all the answers

    Rheumatoid arthritis primarily affects large joints such as the knee more than small joints.

    <p>False</p> Signup and view all the answers

    What is the peak age range for incidences of rheumatoid arthritis?

    <p>40-60 years old</p> Signup and view all the answers

    Rheumatoid arthritis is classified as a type of ______ disease.

    <p>autoimmune</p> Signup and view all the answers

    Match the following features of rheumatoid arthritis with their descriptions:

    <p>Rheumatoid Factor = Autoantibody present in many RA patients ACPA = Anti-citrullinated protein antibody Pannus = Enlarged synovial membrane causing inflammation Cigarette smoking = Environmental factor influencing RA onset</p> Signup and view all the answers

    Which of the following statements is true regarding the prevalence of rheumatoid arthritis?

    <p>It affects 0.5-1% of Caucasian individuals.</p> Signup and view all the answers

    Autoantibodies like RF and ACPA can be detected several years before the clinical manifestations of rheumatoid arthritis.

    <p>True</p> Signup and view all the answers

    What term is used for rheumatoid arthritis that occurs before the age of 16?

    <p>idiopathic juvenile arthritis</p> Signup and view all the answers

    What is the primary infectious agent associated with periodontitis?

    <p>Porphyromonas gingivalis</p> Signup and view all the answers

    Smoking cessation decreases the risk of rheumatoid arthritis (RA) immediately.

    <p>False</p> Signup and view all the answers

    Identify the shared epitope associated with HLA-DR B1.

    <p>5 amino acid sequence from residue 70 to 74 in the DR-beta chain</p> Signup and view all the answers

    The presence of _______ proteins in the bronchoalveolar fluid is a significant factor in the risk of developing RA among smokers.

    <p>citrullinated</p> Signup and view all the answers

    What is the primary role of rheumatoid factor (RF)?

    <p>To recognize the Fc fragment of other antibodies</p> Signup and view all the answers

    Match the following components with their descriptions.

    <p>HLA-DR B1 = Increases risk of RA when associated with smoking Citrullinated proteins = Proteins modified that can trigger autoimmunity Periodontitis = Inflammatory disease similar to RA Pannus = Hyperplastic synovial membrane in RA</p> Signup and view all the answers

    ACPA antibodies are very specific for rheumatoid arthritis but are found in 100% of RA patients.

    <p>False</p> Signup and view all the answers

    How long must a person smoke to have a strong association with ACPA seropositivity?

    <p>20 years</p> Signup and view all the answers

    What is the significance of genetic predisposition in rheumatoid arthritis?

    <p>It involves identified gene polymorphisms, notably HLA-B1.</p> Signup and view all the answers

    Seronegative rheumatoid arthritis patients show positive results for rheumatoid factor (RF).

    <p>False</p> Signup and view all the answers

    The process that converts Arginine into Citrulline during citrullination is performed by the enzyme __________.

    <p>peptidylarginine deiminase</p> Signup and view all the answers

    What changes occur to the synovial membrane in RA as the inflammatory process continues?

    <p>It becomes hyperplastic and hypertrophic.</p> Signup and view all the answers

    Match the following antibodies with their characteristics:

    <p>RF = Found in many autoimmune diseases, not specific for RA ACPA = Very specific to RA, found in 80% of patients Anti-CarP = Found in 45% of RA patients, against carbamylated proteins Seronegative RA = Clinical features of RA without auto-antibodies</p> Signup and view all the answers

    What environmental factor can lead to the citrullination of host proteins?

    <p>Smoking</p> Signup and view all the answers

    Only 25% of rheumatoid arthritis patients are classified as seronegative.

    <p>True</p> Signup and view all the answers

    What is Anti-CarP antibody, and when was it discovered?

    <p>It is an antibody against carbamylated proteins, discovered recently.</p> Signup and view all the answers

    What is the usual percentage for VLCO (carbon monoxide examination) in a healthy individual?

    <p>80%</p> Signup and view all the answers

    Ground glass opacity indicates irreversible lung damage.

    <p>False</p> Signup and view all the answers

    What is the primary reason for requesting a CT scan instead of an X-ray for diagnosing interstitial lung disease (ILD)?

    <p>CT scan can better discriminate ILD.</p> Signup and view all the answers

    Patients with rheumatoid arthritis may develop __________ due to cavitating lung nodules.

    <p>infections</p> Signup and view all the answers

    Match the following manifestations with their descriptions in rheumatoid arthritis:

    <p>Scleritis = Emergency red eye with pain Episcleritis = Less severe eye inflammation Cutaneous vasculitis = Inflammation of small vessels Fetly's syndrome = Triad of arthritis, splenomegaly, granulocytopenia</p> Signup and view all the answers

    Which of the following is an incorrect statement regarding the risk of infection in rheumatoid arthritis patients?

    <p>Patients have a lower risk of infection compared to the general population.</p> Signup and view all the answers

    Rheumatoid arthritis can be diagnosed with a score higher than 6 based on global criteria.

    <p>True</p> Signup and view all the answers

    What is commonly used as the threshold duration of symptoms for diagnosing rheumatoid arthritis?

    <p>6 weeks</p> Signup and view all the answers

    Which of the following lab tests indicates inflammation?

    <p>CRP</p> Signup and view all the answers

    A positive ANA test is exclusively indicative of Rheumatoid Arthritis.

    <p>False</p> Signup and view all the answers

    What imaging technique is considered the best modality to study the bones for erosions in RA?

    <p>CT scan</p> Signup and view all the answers

    The presence of hypervascularization in joints during ultrasound indicates __________ activity.

    <p>inflammatory</p> Signup and view all the answers

    Match the following lab tests with their corresponding purposes:

    <p>CBC = Identifying anemia and leukocytosis CRP = Measuring inflammatory response Creatinine = Kidney function assessment Transaminases = Liver function test</p> Signup and view all the answers

    Which of the following is NOT a differential diagnosis for Rheumatoid Arthritis?

    <p>Tuberculosis</p> Signup and view all the answers

    X-rays can show joint space enlargement in the early stages of Rheumatoid Arthritis.

    <p>False</p> Signup and view all the answers

    What is the significance of testing for ANA subtypes in patients with a positive ANA?

    <p>To differentiate between RA, SLE, and Sjogren’s syndrome.</p> Signup and view all the answers

    Study Notes

    Rheumatoid Arthritis

    • Affects 1% of the general population, most common rheumatoid disease
    • Divided into two main groups: rheumatoid arthritis and spondyloarthritis
    • Characterized by inflammatory pain, not mechanical pain from osteoarthritis
    • Inflammatory arthropathies can be:
      • Monoarthritis (1 joint affected)
      • Oligoarthritis (2-4 joints affected)
      • Polyarthritis (5 or more joints affected)
      • Can be proximal or distal
    • Symmetrical versus asymmetrical is a key difference between rheumatoid arthritis (RA) and spondyloarthritis (SA). RA is typically symmetrical, SA is asymmetrical inflammation.
    • Inflammatory pain peaks at night, due to increased cytokine production early in the morning. Includes signs of rubor, tumor, dolor, and calor.
    • Physical activity often aggravates mechanical pain (osteoarthritis), while inflammatory arthritis pain is typically worse at night and in the morning.
    • Main joints affected are mobile/synovial joints
      • Synovial membrane composed of:
        • Intima, containing synovial macrophages (APCs) and fibroblasts with synthetic capacity (produce hyaluronic acid, lubricin, and other matrix substances.)
        • Subintima, composed of loose connective tissue.
    • Synovial fluid, essential for joint function, is increased in inflamed joints (60-100 mL) compared to normal (5 mL).
    • Chronic systemic autoimmune inflammatory disease with unknown etiology.
    • Affects diarthrodial (movable) joints
    • Bone damage and erosion can occur without treatment
    • Prevention of symptoms and deformities is key
    • High risk of myocardial infarction (MI) and stroke at younger ages in RA patients.
    • Prevalence: 0.5-1% in Caucasians and 5% in Native Americans
    • Higher prevalence in fertile female (estrogens related to autoimmune diseases) - 2.5:1 ratio compared to males)

    Pathophysiology

    • Autoantibody production (Rheumatoid Factor and ACPA are characteristic of RA)
    • Pannus (synovial inflammation)
    • Destruction of cartilage and bone due to inflammation
    • Systemic manifestations can include cardiovascular, pulmonary, or psychiatric complications

    Environmental Factors in RA

    • Cigarette smoking is a significant factor in developing RA.
    • Periodontal infections (e.g., Pseudomonas gingivalis) may play a role.

    Etiology

    • A breakdown in immunological self-tolerance, with unknown initiating trigger
    • Presence of autoantibodies like RF and ACPA years before clinical onset.
    • Genetic predisposition (HLA-B1 is a significant factor)

    Genetic Predisposition

    • Genetic predisposition is essential to the development of RA.
    • Polymorphisms (variations in genes) are significant in predisposition to RA.
    • HLA-B1 is a significant factor

    RF and ACPA

    • RF: Antibody directed against other antibodies. Present in other autoimmune diseases and healthy people, not entirely sensitive or specific for RA
    • ACPA: Anti-citrullinated protein antibody. Highly specific to RA patients, not necessarily sensitive
    • Both RF and ACPA can be present in the blood years before clinical onset

    Clinical Features

    • Constitutional symptoms (fatigue, anemia, weight loss) are initial indicators in some individuals.
    • Arthritis, with initial painful swelling and stiffness of small joints
    • Symmetric involvement of joints is typical
    • Over time, more joints (additive effect) may be involved and disease may progress towards axial joints.
    • Polyarticular (multiple joints) pattern is common, including proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints.
    • Centripetal: The disease progresses from the extremities, to affect the center of the body
    • Exceptions: Palindromic presentations (remission and flare-ups), and presentations starting at the core (like polymyalgia-like)

    Bone Erosion

    • An important characteristic of RA, it is a common manifestation with significant joint damage.
    • Progressive joint destruction and deformities can lead to significant disability.
    • Recognition on X-ray: interruptions in the cortical bone
    • Irreversible within 6 months - 1 year after disease onset.
    • Treatment is crucial, early intervention is essential to mitigate complications and maintain quality of life.

    Extra-articular Manifestations

    • Vasculitis, Amyloidosis, Interstitial lung disease, Serositis, Episcleritis, including pulmonary manifestations.
    • Rheumatoid nodules are a common finding in the skin.
    • Eye problems, such as scleritis or episcleritis, are common.
    • Kidney problems (renal amyloidosis)
    • Other associated systemic complications

    Diagnosis Criteria

    • RA score based on global criteria, assessing features for diagnosis by healthcare professionals using a score and tests
    • Number of involved joints.
    • Serology (RA and ACPA presence).
    • Inflammatory markers (ESR and CRP levels)
    • Duration of symptoms.

    Common Diagnostic Testing

    • Complete Blood Count (CBC).
    • Erythrocyte Sedimentation Rate (ESR)
    • C-reactive protein (CRP)
    • Inflammatory markers.
    • Serum analysis for autoantibodies (RF and ACPA).
    • Antinuclear antibodies (ANA) - to help distinguish RA from other diseases

    Imaging

    • X-rays may be used for assessment (2D limitations)
    • CT scans are often useful in identifying bone erosion and joint damage (3D).

    Treatment

    • Medications for symptom relief (e.g., NSAIDs)
    • Conventional synthetic DMARDs for disease modification (e.g., methotrexate).
    • Biological DMARDs for inhibiting specific biological mechanisms, to decrease immune response (e.g. anti-TNF inhibitors or other biologic agents).

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    Description

    This quiz explores the characteristics and classifications of rheumatoid arthritis and spondyloarthritis. Understand the differences in inflammatory pain, joint involvement, and the key symptoms associated with these conditions. Test your knowledge on how these diseases present and affect the general population.

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