(059) Autoimmune disease and the musculoskeletal system

Question 1

How can leukocytic tolerance be broken ?

Answer 1

• Microbial/Self antigen cross-reaction (molecular mimicry)

• Pathogen alters structure or presentation of self antigen

• Regulatory T cell failure

• Cytokine dis regulation

• Thymic defect

Question 2

Rheumatoid arthritis prevalence ?

Answer 2

common (1% of population)

Question 3

cytokines related to RA ?

Answer 3

-TNF alpha

• IL-1

-IL-6

Question 4

….. is a protein that can be altered to contain citrulline residues during inflammation

Answer 4

vimentin

Question 5

“During inflammation, arginine amino acid residues can be enzymatically converted into citrulline residues in proteins such as vimentin”

This process is called :

Answer 5

citrullination

Question 6

…… have proved to be powerful biomarkers (highly specific) that allow the diagnosis of rheumatoid arthritis (RA) to be made at a very early stage.

Answer 6

Anti-citrullinated protein antibodies (ACPAs)

Question 7

TNF Alpha activates ….. (Cells) in RA , leading to bone resorption

Answer 7

Osteoclasts (bone macrophages)

Question 8

TNF Alpha leads to leukocyte accumulation at site of RA through the process of :

Answer 8

Upregulating E-selectin and VCAM-1 (Vascular Cell Adhesion protein 1)

Question 9

Chondrocytes are activated by the action of ….. (Immune mediator)

Answer 9

TNF Alpha

Question 10

…. (Immune mediator) is responsible for the extensive angiogenesis in RA

Answer 10

TNF Alpha

Question 11

Diagnosis of RA by Blood tests ?

Answer 11

• CBC : Elevated erythrocyte sedimentation rate (ESR) or C-reactiVe protein (CRP) ; indicating inflammation
• Rheumatoid factor ,, and cyclic citrullinated peptide (anti-CCP) antibodies.

Question 12

Imaging diagnosis of RA ?

Answer 12

• X-rays to help track the progression of rheumatoid arthritis in your joints over time.
• MRI and ultrasound tests can help in early diagnosis of inflammation and to detect severity of the disease in your body.

Question 13

List methods of treating RA

Answer 13

1- Nonsteroidal anti-inflammatory drugs (NSAIDs)

2- Steroids

3- Disease-modifying antirheumatic drugs (DMARDs)

4- Biologic agents

Question 14

Role of NSAIDs in RA treatment ?

Answer 14

relieve pain and reduce inflammation

Question 15

Role of Steroids in RA treatment ?

And give an example

Answer 15

• reduce inflammation and pain and slow joint damage
• Example : prednisone

Question 16

Side effects of steroidal treatment of RA ?

Answer 16

Side effects may include thinning of bones, weight gain and diabetes

Question 17

How are steroids often used in the treatment of RA ?

Answer 17

Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication

Question 18

Disease-modifying antirheumatic drugs (DMARDs) ?

Answer 18

These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage.

Common DMARDs include methotrexate, hydroxychloroquine (Plaquenil) and sulfasalazine (Salazopyrine)

Question 19

Famous synthetic DMARDs ?

Answer 19

-methotrexate

-hydroxychloroquine (Plaquenil)

-sulfasalazine (Salazopyrine)

Question 20

Biological DMARDs that inhibit TNF-Alpha ?

Answer 20

-Infliximab

-Etanercept

-Adalimumab

Question 21

Biological DMARDs that inhibit IL-1 ?

Answer 21

Anakinra

Question 22

Biological DMARDs that inhibit IL-6 ?

Answer 22

Tocilizumab

Question 23

Biological DMARDs that inhibit B Cell depletion ?

Answer 23

Rituximab

Question 24

Biological DMARDs that inhibit co-stimulation?

Answer 24

Abatacept

Question 25

Prevalence of Polymyositis/dermatomyositis ?

Answer 25

Fairly rare (prevalence 1 in 20,000)

Question 26

What is Polymyositis/dermatomyositis ?

Answer 26

Muscle disease associated with inflammation and autoantibodies to histidyl-tRNA synthetase

Question 27

the auto-antigen of Polymyositis/dermatomyositis ?

Answer 27

histidyl-tRNA synthetase

Question 28

In polymyositis ; associated skin involvement occurs in …..% of cases

Answer 28

50-60%

Question 29

This a microscopy of polymyositis : explain the found abnormality

Answer 29

Question 30

Describe the microscopical abnormality ,, and give your diagnosis

Answer 30

Question 31

Treatment options in polymyositis/dermatomyositis ?

Answer 31

-Corticosteroids

• synthetic DMARDs (Methotrexate)
• Azathioprine
• Intravenous immunoglobulin

Question 32

Commonest treatment for MG ?

Answer 32

Acetylcholinesterase inhibitors