Systemic Pathology > Lecture 5 > Flashcards

Lecture 5 Flashcards

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1
Q

Does Rheumatoid athritis affect female or male more?

A

Female

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2
Q

What are comorbidities of rheumatoid athritis?

A

cardiovascular diseases such as
hypertension, diabetes, hyperlipidemia, obesity and
periodontal disease

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3
Q

What are risk factors of RA?

A
  • Susceptibility genes (HLA-DRB1)
  • Epigenetic modifications
  • Smoking
  • Microbiota
  • Female sex
  • Western diet
  • Ethnic factors
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4
Q

What is the pathophysiology of Rheumatoid Arthritis?

A

Autoimmune disease → body attacks synovial joints.

Chronic inflammation of synovium → forms pannus (abnormal granulation tissue).

Pannus erodes cartilage, bone, and ligaments.

Leads to joint deformity, pain, stiffness, and loss of function.

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5
Q

What are the 4 RA joint Pathology?

A
  1. Synovial membrane inflammation (synovitis)
  2. Production of inflammatory cytokines and degrading enzymes
  3. Cartilage and bone erosion
  4. Synovial fluid contains inflammatory cells
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6
Q

What are the histological features of RA?

A

hyperplasia of the synovial
membrane with infiltration by
lymphocytes and plasma cells.

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7
Q

What are the signs and symptoms of RA?

A

Usually gradual in onset
* Affects many joints (polyarticular) = Hands, shoulder, elbow, knee, feet, spine
* Morning stiffness is a prominent feature ≥ 60 minutes
* Signs of inflammation; redness, swelling, pain etc
* Fluid increases in and around the inflamed joint

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8
Q

Within what timeframe can radiographic abnormalities appear in RA?

A

Within less than 2 years.

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9
Q

What is the earliest radiographic finding in RA hand joints?

A

Soft tissue swelling.

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10
Q

What type of bone destruction is seen at joint margins in RA?

A

Marginal joint erosion (destruction of bone at joint edges).

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11
Q

On which side of the MCP joints are erosions frequently seen in RA?

A

On the radial side.

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12
Q

What kind of bone loss occurs near RA-affected joints, especially early?

A

Juxta-articular osteoporosis (bone loss near joint edges).

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13
Q

Which hand joints are most commonly affected in RA?

A

PIP (proximal interphalangeal) and MCP (metacarpophalangeal) joints, usually symmetrical.

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14
Q

Which joints of the hand are usually spared in RA?

A

DIP (distal interphalangeal) joints.

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15
Q

What happens to joint space in later stages of RA?

A

Joint space narrowing.

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16
Q

What deformities are seen in end-stage RA hand joints?

A

Boutonnière deformity = flexion of PIP, hyperextension of DIP.

Swan-neck deformity = hyperextension of PIP, flexion of DIP.

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17
Q

What overall consequence can RA hand changes lead to?

A

Joint misalignment, displacement, and significant disability.

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18
Q

How does RA initially present in the shoulder?

A

Mimics rotator cuff tendonitis with painful arc syndrome and night pain in upper arms.

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19
Q

What are later consequences of RA in the shoulder?

A

Global stiffening, rotator cuff tears, interfering with daily tasks (e.g., dressing, feeding).

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20
Q

What is the late effect of RA in the elbows?

A

Loss of flexion → severe difficulty with daily activities.

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21
Q

Which joints of the foot are most affected by RA, and what deformity develops?

A

MTP joints (painful & swollen) → foot becomes broader with hammertoe deformity.

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22
Q

What secondary problems occur in RA-affected feet?

A

Ulcers/calluses under metatarsal heads & dorsum of toes; flat medial arch; ankle valgus deformity.

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23
Q

What are the main knee pathologies in RA?

A

Synovitis, effusions, cartilage & bone erosion, varus/valgus deformity, with secondary OA.

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24
Q

How commonly are hips affected in RA compared to knees?

A

Less common than knees.

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25
Which part of the spine is most affected in RA?
Upper cervical spine (especially atlantoaxial joint).
26
What complications occur with RA in the cervical spine?
Synovitis & bone destruction → ligament damage → atlantoaxial instability → subluxation → potential cord compression.
27
What are the red flag signs of cervical spine involvement in RA?
Unexplained difficulty walking Weakness of legs Loss of bladder or bowel control
28
Extra-Articular Manifestations of RA
29
What can happen to the soft tissue surrounding joints extra-articular manifestations of RA?
- Rheumatoid nodules - Bursitis - Tenosynovitis of flexor tendons in the hand can cause stiffness and occasionally trigger finger
30
What can happen to the lungs extra-articular manifestations of RA?
- FLuid in pleural space - Inflammation and fibrosis
31
What can happen to the blood vessels extra-articular manifestations of RA?
- Vasculitis of the skin
32
What is Raynauds Phenomenon in extra-articular manifestations of RA?
Spasms of blood vessels in in response to cold, stress, or emotional upset causes decreased blood flow to the fingers--- fingers turn pale or white then blue
33
What is carpal tunnel syndrome in extra-articular manifestations of RA?
* Compression on the median nerve at the wrist * Signs/symptoms: numbness, tingling, and pain in the arm, hand, and fingers
34
What are some systemic signs and symptoms of Rheumatoid Athritis?
- Fever - Weight loss - Anorexia - Fatigue - Sleep Disturbance
35
What is the HAQ for?
Used in Rheumatology clinic to asses functional status: * Dressing and Grooming * Arising * Eating * Walking * Hygiene * Reach * Grip
36
What autoantibody is often present in RA but is not specific to it?
Rheumatoid Factor (RF).
37
Why is a positive RF test clinically important in RA?
RF-positive patients tend to have more erosive disease.
38
Which autoantibody is more specific for RA and appears early in disease course?
Anti-Citrullinated Protein Antibodies (ACPA).
39
What inflammatory markers may be elevated in RA but are not specific?
C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR).
40
What ESR/CRP score supports a diagnosis of RA?
≥ 6 = definite RA.
41
What is the target population for RA diagnostic criteria?
Individuals with at least one clinically swollen joint not explained by another disease.
42
RA vs OA
43
What are current RA treatments?
- Anti inflammatory medications (NSAIDS) - Disease Modifying Anti Rheumatic Drugs (DMARDs) - Surgical treatments
44
What is spondyloarthritis?
a group of condi;ons affec2ng the spine and peripheral joints with familial clustering and a link to HLA B27 an;gen.
45
What does axial SpA affect?
Mainly spine and sacroilliac joints - Ankylosing Spondylitis
46
What does peripheral SpA affect?
Mainly arms, legs,, fingers, toes - Psoriatic arthritis - Reactive arthritis
47
Axial Spondyoarthritis
Symptoms affect the axial joints—spine, chest, and the sacroiliac joint (hip bone)
48
Peripheral Spondyloarthritis
Affect other joints, such as the knees or finger or toe joints
49
What makes SpA different from Rheumatoid Arthritis?
* No rheumatoid factor in blood (so “seronegative”) * Strong link with HLA-B27 * Pathologic changes in the ligamentous attachments rather than synovium * Involvement of sacroiliac (SI) joints * Can cause new bone formation → joint fusion (ankylosis)
50
Common Characteristics of SpA
* Back or joint pain (inflammatory type) * Enthesitis → pain where tendon/ligament attaches (e.g., heel, Achilles tendon) * Eye inflammation (uveiNs) → red, painful, blurred vision * Skin/nail changes → psoriasis, nail pittng (in PsA) * Gut inflammation → sometimes bowel disease links * Rare heart involvement → aortitis, valveproblems
51
Genetic link in SpA
HLA-B27 gene present in: * 90% of Caucasians with AS * ~50% with PsA * Increases risk of Reactive Arthritis after infection
52
Ankylosing spondylitis (AS) Who gets it?
* Usually young adults (<40 years) * More common in men (3:1 ratio) * Strong genetic link: HLA-B27 positive in ~95% of Caucasian patients
53
AS:Key Symptoms
It presents with inflammatory back pain and sacroiliac inflammation Inflammatory back pain: * Starts slowly (insidious onset) * Morning stiffness >30 min * Improves with exercise 🏃, not with rest 🛏 * Pain at night, better when moving around Sacroiliac joint inflamma;on → buttock pain (sometimes alternating sides)
54
Which genetic test is commonly positive in AS?
HLA-B27 test.
55
Which blood markers are usually increased in AS due to inflammation?
ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein).
56
What is the most important imaging modality for diagnosing AS?
X-rays (especially of sacroiliac joints).
57
What are the key X-ray findings in AS?
Erosion & fusion of sacroiliac joints Enthesitis (inflammation where tendons/ligaments attach to bone) Syndesmophytes (small bony growths along spinal ligaments) Bamboo spine (calcification of ligaments + fusion of facet joints + syndesmophytes).
58
What causes the “bamboo spine” appearance on X-ray in AS?
Calcification of intervertebral ligaments + fusion of spinal facet joints and syndesmophytes.
59
What term is used if radiographic signs of axial spondyloarthritis are seen?
rAxSpA (radiographic axial spondyloarthritis).
60
Which imaging technique is more sensitive than X-ray for early detection of AS?
MRI
61
Criteria for Axial/Ankylosing Spondylitis
1. Age of onset <45 years 2. Duration >3 months 3. Insidious onset 4. Morning stiffness >30 minutes 5. Improvement of back pain with exercise 6. No improvement of back pain with rest 7. Back pain at night with improvement on getting up 8. Alternating buttock pain
62
What is the management of AS?
* Exercise & posture training → keeps spine flexible and prevents deformity * NSAIDs = first-line for pain/inflammation * DMARDs (like sulfasalazine) → help peripheral arthri4s, not spine * Biologics (TNF-α blockers) if NSAIDs fail * Prognosis: With good exercise + treatment, most pa4ents live normally (80% remain fully employed)
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Interventions for low back pain
Active interventions: exercise, yoga, active lifestyle etc * Physical passive interventions: * Spinal manipulations * Massage * Transcutaneous electrical nerve stimulation (TENS)
66
Psoriatic Arthritis (PsA)
An inflammatory arthritis that happens in people with psoriasis - Psoriasis=skin rash, pink plaque top with a scale
67
PsA Clinical Features
68
Symetrical polyarthritis
(many joint involvement)—often in women
69
Asymmetrical Oligoarthritis
(few joints involved)
70
DIP
(Distal Interphalangeal Joint) involvement
71
Sausage fingers (dactylitis)
72
Arthritis mutilans)
Finger shortening due to osteolysis of the phalanges
73
X-ray Joint in PsA
Bone erosion (osteolysis) of the metatarsal heads with central erosion of the proximal phalanges to produce the ‘pencil in cup’ appearance * Inflammation of the periosteum (periostitis)
74
PsA Treatment
* Anti inflammatory drugs (NSAID) * Disease Modifying Anti Rheumatic Drug (DMARDs) * Intra-articular corticosteroid injections-- for local synovitis * TNF-α-blocking drugs if NSAID failed * bDMARD (biologic Disease Modifying Anti Rheumatic Drug)
75
Non-Medication Modalities for PsA
* Rest: Local and systemic * Exercise: Passive, active, stretching, strengthening, and endurance * Modalities: Heat, cold * Orthotics: Upper and lower extremities, spinal * Assistive devices for gait and adaptive devices for self-care tasks * Education about the disease, energy conservation techniques, and joint protection
76
Reactive Arthritis (Reiter syndrome)
A sterile synovitis (inflammation of the synovial membrane), which occurs following an infection—immune response
77
How does Reactive Arthritis develop:
in 1–2% of patients after infection with: * GIT infections: Shigella, Salmonella, Campylobacter etc * Genitourinary infection (in particular Chlamydia trachomatis) In males, positivity for HLA-B27 increases the risk developing reactive arthritis by 30–50-fold after infections
78
Clinical Features of Reactive Athritis
- Arthritis * Acute, asymmetrical, predominantly lower-limb * Days to weeks after the infection. * Enthesitis is common, causing plantar fasciitis or Achilles tendon enthesitis - Conjunctivitis - Urethritis (cervicitis in women)
79
Treatment for Reactive Arthritis
- NSAIDs or corticosteroids - Antibiotics * Alters the course of the arthritis, once it has developed * Cultures should be taken and any infection treated. Sexual partners must be screened - DMARDS
80
Comparison of Spondyloarthropathies
Systemic Pathology
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