17

Question 1

_ is a marker for rheumatoid arthritis

antibody against the Fc portion of IgG

Answer 1

RF-rheumatoid factor -

the classic RF is an IgM antibody with this kind of activity

Question 2

Ab’s directed against _ proteins are frequently discovered in RA patients

these Ab’s often appear years before joints are affected

Answer 2

citrullinated proteins

Citrullination of peptides catalyzed by PAD(peptidyl arginine deaminase)

CCP cyclic citrullinated peptides - related to periodontal disease?

Question 3

P gingivalis has an enzyme that can convert arginine to _, same enzyme related to RA

Answer 3

citrulinne

PAD enzyme (peptidyl arginine deaminase) - tissue destruction

Question 4

drugs to treat Rheumatoid Arthritis

Answer 4

1. NSAIDS
2. DMARDS - disease mod anti rheumatic drugs
3. glucocorticoids
4. pain meds - opiods

Question 5

_ drugs slow down disease progression in RA

NSAIDS - treat inflammation but not underlying cause

SAIDS - corticoids - blunt the immunse response but do not slow down the progression of disease

Answer 5

DMARDS

Question 6

what is methotrexate

Answer 6

a DMARD

acts as an immunosupressant

also NSAID taken with it

Question 7

enzyme inhibitor of dihydrofolate reductase

interfers with folate metabolism acts as a chemotheapeutic agent - not whats going on here - too low of a dose when used for RA to inhib the DHFR

Answer 7

methotrexate
Chemotherapeutic agent
Need folate for synthesis and shit

Inhibs DHFR enzyme - thus inhibiting nucleic acid and protein/aa synthesis

really whats going on it potentiation of adenosine signaling as a immune modulator

Question 8

BOTTOM LINE - low dose methotrexate treatment prodcues _ and _ effects

Answer 8

immunosuppressive and anti-inflammatory effects

reduction of cell proliferation
enhanced apoptosis of T cells
increased adenosine release
altered expression of cellular adhesion molecules
influences cytokine production

Question 9

in patients with RA that is not well controlled with Methotrexate - treatment with biologicals that disrupt _ signaling is the next option

Answer 9

disrupt TNFalpha

Adalimumab (Humira) - a monoclonal antibody (IgG) directed against TNFalpha is the best known

IgG SC admin and anti-TNF

Question 10

RA patient - methotrexate isn’t working so we block TNFa and what does that do

Answer 10

TNFa is a pleotropic cytokine - plays a major role in the immune/inflammatory response

Ab’s directed against TNFa inhibit other proinflammatory cytokins - IL6 IL1 GM-CSF

they act as DMARDS in RA and have positive effects on a slew of autoimmune disorders

Question 11

IgG is a _ structure

Answer 11

tetrameric quaternary

Fc region - constant

Fab region - Ab