Rheumatoid Arthritis

Question 1

• Chronic systemic inflammatory dse with unknown etiology

Answer 1

RHEUMATOID ARTHRITIS

Question 2

RA Hallmark feature

Answer 2

Persistent symmetric inflammatory peripheral polyarthritis (SYNOVITIS)

Question 3

Cigarette Smoking, Infection, and Trauma are the external triggers of RA

(CIT)

Answer 3

TRUE

Question 4

Goals of RA Treatment

Answer 4

• Decrease joint inflammation
• Arrest dse progression

Question 5

Important short-term option for controlling pain and inflammation

Rarely used w/o concomitant DMARD use

Should be tapered as soon as possible

Answer 5

NSAIDS

Question 6

Prevent prostaglandin production by INHIBITING COX ENZYME

Answer 6

Aspirin and other NSAIDs

Question 7

Inhibit SPECIFIC FORM OF COX-2

Answer 7

COX-2 Inhibitors

Question 8

• Control pain and inflammation during EARLIER STAGES of RA
• Facilitate REMISSION during ACUTE FLARE-UPS and DECREASE DISABILITY
• Early use = DECREASE EROSION AND DAMAGE

“BRIDGE”

Answer 8

Glucocorticoids

Question 9

• Inhibits proinflammatory substances
• Inhibits transcription factors that initiates synthesis of proinflammatory cytokines, enzymes, and receptor proteins
• increase production of annexins (lipocortins)

Answer 9

Glucocorticoids

Question 10

• inhibits T cell function
• irreversible retinal damage
• eye examination

Answer 10

CHLOROQUINE

Question 11

Inhibit toll-like receptors

6-6.5 mg/kg

Answer 11

HYDROXYCHLOROQUINE

Question 12

• imidazolyl derivative of 6-mercaptopurine
• inhibit many aspects of B and T cell function
• Neutropenia
• Relatively high toxicity
• Used cautiously for those debilitated or with renal dse

Answer 12

AZATHIOPRINE

Question 13

• inhibit mononuclear phagocytes
• bind strongly to specific proteins
• increases expression of anti-inflammatory proteins
• reduced synthesis of prostaglandin E2 and other inflammatory mediators

Answer 13

GOLD COMPOUNDS

Question 14

• Intramuscular
• effects occur faster than oral gold
• long delay of 4 mos

Answer 14

GOLD SODIUM THIOMALATE

Question 15

• inhibits dihydroorotate dehydrogenase (mitochondrial enzyme in de novo pyramidine synthesis)

• antiproliferative activity and anti-inflammatory effexts

• decrease joint erosion/destrcution with relatively few side effects

• long term side effects TBD

Answer 15

LEFLUNOMIDE

Question 16

• inhibits DNA synthesis
• anything w/ folate
• assoc w pulmo probs

• PRIMARY DRUG when treating RA, yet other agents can be added

Answer 16

METHOTREXATE

Question 17

• sequester harmful chemicals (reactive aldehydes)
• influence T CELL ACTIVITY AND IMMUNE FUNCTION
• aplastic anemia
• pemphigus
• MYASTHENIA GRAVIS
• relatively high incidence of toxicity

Answer 17

PENICILLAMINE

Question 18

• inhibition of ARACHIDONIC ACID CASCADE (sulfing the sea)
• modulate LEUKOTRIENES
• may produce serious hypersensitivity reactions and blood dyscrasias

Answer 18

SULFASALAZINE

Question 19

Adalimumab (Human IgG1 mAb)

Certolizumab (PEGylated Fab mAb fragment)

Etanercept (TNFR2 Fc fusion protein)

Golimumab (Human IgG1K mAb)

Infliximab (Chimeric mAb)

Answer 19

Tumor Necrosis Factor Inhibitors (TNFIs)

Question 20

• suppresses T cell activation

Answer 20

ABATACEPT

Question 21

• blocks interleukin-1 (IL-1) receptor to protect against autoinflammatory events
• should not be used with TNFIs

Answer 21

ANAKINRA

Question 22

• Recombinant humanized interleukin-6 (IL-6) receptor monoclonal antibody
• IgG1K subclass
• Often combined witt methotrexate if other DMARDs not effective

Answer 22

TOCILIZUMAB

Question 23

• GENETICALLY-ENGINEERED CHIMERIC MURINE/human monoclonal IgG

Answer 23

RITUXIMAB