15. Rheumatology And Immunosuppression

Question 1

What is rheumatoid arthritis?

Answer 1

• an inflammatory, autoimmune condition
  -multisystem involving joints, lungs, liver etc
  Initially localised to the synovium but inflammatory change and proliferation of synovium (pannus) leads to dissolution of the cartilage and bone.

Question 2

How do we diagnose RA?

Answer 2

• morning stiffness >1 hr
  -arthritis of > 3 joints
  -arthritis of hand joints
  -symmetrical arthritis
  -rheumatoid nodules
  -serum rheumatoid factor
  X-ray changes

There is a scoring system and the higher the score the more likely it is RA.

Question 3

What are the treatment goals in RA?

Answer 3

• symptomatic relief
• prevention of joint destruction
• early use of DMARDs

Want to achieve good disease control, use fo adequate dosages, combinations fo drugs and avoiding long term corticosteroids.

Question 4

What is SLE?

Answer 4

Systemic lupus erythematosus is an autoimmune disease where the body’s immune system mistakenly attacks healthy tissues. A few common symptoms include:

• painful and swollen joints
• extreme fatigue
• myalgia, myositis, arthritis, arthralgua
• ulcers in mucous membranes
• butterfly rash
• heart and lung problems
• hypertension, oedema, proteinuria, renal failure

Question 5

What is vasculitis?

Answer 5

Vasculitis is a group of diseases which results in the inflammation of blood vessels.

Examples of vasculitis include Wegeners granulomatosis, temporal arteritis and Henoch-Schonlein purpura.

Vasculitis can also accompany infections, cancers, and rheumatic diseases such as RA or SLE.

Question 6

What are the 4 classes of immunosuppressants use to treat rheumatological disorders?

SCAB

Answer 6

S: steroids e.g. prednisolone, methylprednisolone

C: cytokine inhibitors e.g. cyclosporine, tacrolimus

A: Antimetabolities e.g. methotrexate, azathioprine

B: biological agents e.g. adalimumab, infliximab, etanercept

Other DMARDs include: sulphasalazine, Anti-TNF agents, Rituximab and cyclophosphamide

Question 7

What is the mechanism of action of corticosteroids?

Answer 7

• bind to intracellular cytoplasmic receptors
• activated receptors then bind in the nucleus to either promote or inhibit gene transcription
• slower response, but result in production of anti inflammatory proteins (IL-1, IL-6)