Rheumatoid Arthritis (Test questions with correct answers)

Arthritis: definition correct answers type of rheumatic (rheumatism is non-specific term for disorders affecting joints and connective tissue) disease, which involves inflammation of a joint or joints; most common types are osteoarthritis, rheumatoid arthritis and gout Rheumatoid Arthritis (RA) correct answers chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints, typically with periods of remission and exacerbation; frequently accompanied by extraarticular (systemic) manifestations. Women more likely to have RA; affects all ethnic groups; risk increases with age, peaking between 30 and 50 years old; increased stress linked; family history might be genetic link RA and Osteoarthritis: principle differences correct answers LOCAL: OA (joint pain is predominate symptom; early morning stiffness usually resolves in 30 min; joints affected asymmetrically) vs RA (morning stiffness does not resolve easily; joints affected symmetrically SYSTEMIC: OA (NONE) vs RA (fatigue, fever, organ involvement) RA: pathophysiology correct answers 1) antigen (not same for all patients) triggers ABNORMAL immunoglobulin G (IgG); rheumatoid factor (RF) autoantibodies respond to the abormal IgG and combines with IgG to form complexes that deposit on synovial membranes and cartilage in joints, thus stimulating activation of complement and inflammatory response. 2) Neutrophils (elevated WBC count) migrate to site (chemotaxis) and release proteolytic enzymes that damage cartilage and cause synovial lining to thicken; CD4 T helper cells stimulate monocytes, macrophages to secrete inflammatory cytokines including interleukin-1 and -6 and tumor necrosis factor (TNF). 3) Vascular granulation tissues grows across the cartilage (pannus) with loss of cartilage beneath expanding pannus; pannus causes cartilage destruction and bone erosion; joint deformities develop and bone density decreases (osteoporosis) How does the autoimmune theory explain the etiology of rheumatoid arthritis? correct answers RA probably triggered from combination of genetics and environment; thought to begin when susceptible person has initial immune response to antigen, e.g., bacterium or virus; strongest genetic evidence is role of human leukocyte antigens (HLA), esp. HLA-B27 (HLAs are also associated with DM type 1); smoking increases risk for predisposed patients What are the clinical manifestations of Rheumatoid Arthritis (RA)? How does Rheumatoid arthritis affect joints? correct answers Systemic: Fatigue, Anorexia, Weight loss, Generalized stiffness, Local: Joints are tender, painful, stiff, swollen and warm to touch; joint symptoms are symmetrical; frequently attacks wrists, hands (small joints usually attacked first), elbows, shoulders, knees and ankles; morning stiffness that can last an hour or more; joint pain increases with movement; tenosynovitis (inflammation of fluid-filled sheath surrounding tendon); Rheumatic nodules Destroys joints; causes joint deformities (as RA progresses, inflammation & fibrosis of joint capsule and supporting structures lead to deformity/disability); causes cartilage and bone density