RA

Question 1

In the treatment of rheumatoid arthritis

a. methotrexate inhibits DNA synthesis in immune cells

Answer 1

A. False. This is leflunomide, Methotrexate MOA in RA unclear but:

• Increases extracellular adenosine  increase adenosine A2A receptor signalling  decrease inflammation
• Increases ROS in T-cells  apoptosis
• Reduces expression of adhesion molecules  VCam- 1, I-Cam, E-selection
• Decreases pro-inflammatory cytokines
• Suppresses early T- and B-cell proliferation
• Decrease antibody formation to TNF-α McABs

Question 2

In the treatment of rheumatoid arthritis

b. leflunomide is safe to use during pregnancy

Answer 2

B. False. CI in pregnancy. Requires 2-year washout period

Question 3

In the treatment of rheumatoid arthritis

c. infliximab binds to TNF-α

Answer 3

C. True. Infliximab has a high-affinity for TNF-α

Question 4

In the treatment of rheumatoid arthritis

d. folic acid supplementation aggravates methotrexate-induced hepatotoxicity

Answer 4

D. False. Folic acid reduces methotrexate associated adverse effects

Question 5

In the treatment of rheumatoid arthritis

e. sulfasalazine is hepatotoxic

Answer 5

E. True. Sulfasalazine is

• Hepatotoxic
• Myelotoxic
• Hypersensitivity
• Megaloblastic anaemia

Question 6

Disease modifying agents in rheumatoid arthritis

a. methotrexate causes mucosal ulceration

Answer 6

A. True, Methotrexate causes:

• Hepatotoxic
• Mucosal ulceration & bleeding (Mouth ulcers common)
• Nephropathy

Question 7

Disease modifying agents in rheumatoid arthritis

b. leflunomide inhibits T-cell proliferation

Answer 7

B. True, inhibits mononuclear and Tcell proliferation  Active metabolite  Inhibits dihydroorotate dehydrogenase  No pyrimidine (uridine) synthesis  Decrease synthesis of DNA/RNA in immune cells

Question 8

Disease modifying agents in rheumatoid arthritis

c. sulfasalazine increases TNF-α levels in arthritic joints

Answer 8

C. False. Sulfasalazine

• Decrease RF
• Inhibits T cell response
• Decrease B cell antibody production
• Decrease IL-1, IL6, IL12, TNF-α
• MOA ≠ Cox inhibition

Question 9

Disease modifying agents in rheumatoid arthritis

d. infliximab is safe to use in patients with latent tuberculosis

Answer 9

D. False. Infliximab increases infection risk

Question 10

Disease modifying agents in rheumatoid arthritis

e. hydroxychloroquine is a folic acid antagonist

Answer 10

E. False. MOA unknown. Methotrexate is a folic acid antagonist n cancer

Question 11

The following is/are true regarding rheumatoid arthritis:

a. NSAIDS prevent the formation of bone lesions

Answer 11

A. False. IL-6 receptor prevents osteoclastic activity

Question 12

The following is/are true regarding rheumatoid arthritis:

b. Methotrexate is hepatotoxic

Answer 12

B. True, Methotrexate causes:

• Hepatotoxic
• Mucosal ulceration & bleeding (Mouth ulcers common)
• Nephropathy

Question 13

The following is/are true regarding rheumatoid arthritis:

c. Hydroxychloroquine increases the risk of ocular damage

Answer 13

C. True

Question 14

The following is/are true regarding rheumatoid arthritis:

d. Leflunomide is safe to use during pregnancy

Answer 14

D. False.

Question 15

The following is/are true regarding rheumatoid arthritis:

e. Infliximab increases circulating TNF-α levels

Answer 15

E. False, decreases by binding to both circulating and membrane bound

Question 16

Treatment of rheumatoid arthritis

a. Rituximab stimulates antibodies by B-cells

Answer 16

A. False. Cause depletion of circulating B–cells by ADCC, CDC, Apoptosis

Question 17

Treatment of rheumatoid arthritis

b. Etanercept binds to TNF-α receptors

Answer 17

B. True.

Question 18

Treatment of rheumatoid arthritis

c. Infliximab increases the risk for upper respiratory tract infections

Answer 18

C. True, UTIs and URTI

Question 19

Treatment of rheumatoid arthritis

d. Tocilizumab is safe to use in children

Answer 19

D. True. Treatment for juvenile RA of >2years

Question 20

Treatment of rheumatoid arthritis

e. Methotrexate adverse effects are reversed by folic acid

Answer 20

E. False. Reduced

Question 21

In the treatment of rheumatoid arthritis

a. Methotrexate inhibits the action of tumour necrosis factor

Answer 21

a. False. Methotrexate MOA in RA unclear but:
- Increases extracellular adenosine  increase adenosine A2A receptor signalling  decrease inflammation
- Increases ROS in T-cells  apoptosis
- Reduces expression of adhesion molecules  VCam- 1, I-Cam, E-selection
- Decreases pro-inflammatory cytokines
- Suppresses early T- and B-cell proliferation
- Decrease antibody formation to TNF-α McABs

Question 22

In the treatment of rheumatoid arthritis

b. Leflunomide is safe to use during pregnancy

Answer 22

b. False. CI and requires 2 year wash out period

Question 23

In the treatment of rheumatoid arthritis

c. Infliximab decreases circulating tumour necrosis factor

Answer 23

c. True, both circulating and bound

Question 24

In the treatment of rheumatoid arthritis

d. Hydroxylchoroquine inhibits COX II in the inflammatory joints

Answer 24

d. False, anti malarial drug

Question 25

In the treatment of rheumatoid arthritis | e. Rituximab decreases B-cell responses

Answer 25

e. True

Question 26

In the treatment of rheumatoid arthritis, methotrexate causes bone marrow suppression

Answer 26

True

Question 27

Prednisone decreases inflammation in rheumatoid arthritis

Answer 27

True

Question 28

Probenecid is used in the treatment of rheumatoid arthritis

Answer 28

False. Gout

Question 29

Match the mechanism of action with the rheumatoid arthritis agents 1. methotrexate a. TNF-α inhibitor b. Inhibits DHFR c. B-cell inhibitor (CD20) d. dihydroorotate dehydrogenase e. Inhibits T cell response

Answer 29

b. Inhibits DHFR

Question 30

Match the mechanism of action with the rheumatoid arthritis agents 2. etanercept a. TNF-α inhibitor b. Inhibits DHFR c. B-cell inhibitor (CD20) d. dihydroorotate dehydrogenase e. Inhibits T cell response

Answer 30

a. TNF-α inhibitor

Question 31

Match the mechanism of action with the rheumatoid arthritis agents 3. rituximab a. TNF-α inhibitor b. Inhibits DHFR c. B-cell inhibitor (CD20) d. dihydroorotate dehydrogenase e. Inhibits T cell response

Answer 31

c. B-cell inhibitor (CD20)

Question 32

Match the mechanism of action with the rheumatoid arthritis agents 4. sulfasalazine a. TNF-α inhibitor b. Inhibits DHFR c. B-cell inhibitor (CD20) d. dihydroorotate dehydrogenase e. Inhibits T cell response

Answer 32

e. Inhibits T cell response

Question 33

Match the mechanism of action with the rheumatoid arthritis agents 5. leflunomide a. TNF-α inhibitor b. Inhibits DHFR c. B-cell inhibitor (CD20) d. dihydroorotate dehydrogenase e. Inhibits T cell response

Answer 33

d. dihydroorotate dehydrogenase