3.4.1 & 3.4.2 Rheumatoid Arthritis

Question 1

Can osteoarthritis be catagorized as inflammatory or non-inflammatory arthritis?

Answer 1

Non-inflammatory

Question 2

Can RA be characterized as inflammatory or non-inflammatory arthritis?

Answer 2

Inflammatory

Question 3

What area of the hand will be affected by osteoarthritis but not RA?

Answer 3

Distal interphalangeal joints (DIPs)

Question 4

How long will it take a patient with RA to relieve their morning stiffness as opposed to a patient with osteoarthritis?

Answer 4

RA is usually greater than an hour and osteoarthritis is less, much less

Question 5

What is this an image of?

Answer 5

Really shitty RA

Question 6

Answer

Answer 6

Osteoarthritis - morning stiffness is relatively short, DIPs are involved, bony appearing changes

Question 7

What are the three extraarticular manifestations associated with Felty’s syndrome?

Answer 7

Splenomegaly, leukopenia, and RA

Question 8

What is the important allele associated with RA?

Answer 8

HLA-DRB1 locus - involved in MHC presentation

Question 9

What are some environmental risk factors associated with RA?

Answer 9

Caplan’s syndrome, Smoking, Periodontal disease, and changes in the gut microbiome

Question 10

Who are the important player in the adaptive immune system involvement in RA?

Answer 10

TH17, B cells and their autoantibodies

Question 11

Who is the key mediator in the innate immune system involvement in RA?

Answer 11

Macrophages - activate downstream cells

Question 12

When looking at this image what is the important area?

Answer 12

The circled cells should not be there

Question 13

What is synovitis?

Answer 13

inflammation in the synovial cells

Question 14

What cells are responsible for the breakdown of the bone in RA?

Answer 14

Osteoclasts

Question 15

What are the two main test used to assist with diagnosing RA?

Answer 15

RF and CCP

Question 16

Why is the Rheumatoid Factor iffy?

Answer 16

The sensitivity and specificity are relatively low - possibility of false positives

Sensitivity 70-80%

Specificity 70%

Question 17

Why is the Anti-cyclic citrullinated peptide test slightly improved over RF?

Answer 17

The specificity is slightly higher at 95% - there will be much fewer false positives

Question 18

Why is smoking put people at an increased risk for RA?

Answer 18

Smoking promotes PAD enzymes and citrullination in the lungs

Question 19

What is the difference between seropositive and seronegative RA?

Answer 19

Some individuals are negative for both RF and CCP - they are referred to as seronegative. These have a better clinical outcome

Question 20

What is important to note about this?

Answer 20

The washed out color or the joints and no DIP involvement

Question 21

Why is the arrow pointing here

Answer 21

This is erosion of the ulnar styloid and it is a major key to RA

Question 22

When trying to figure out a diagnosis of RA would you see this in a normal or abnormal patient?

Answer 22

This is not a normal ultrasound image. This patient is more likely to have RA

Question 23

Match each image with the following:

Early onset RA

Long Term RA

Psoriatic Arthritis

Answer 23

Left to right

Early onset RA

Long Term RA

Psoriatic Arthritis

Question 24

Is the leukocyte count going to be higher or lower in RA vs osteoarthritis?

Answer 24

In RA it is going to be elevated over 2000 vs osteoarthritis it is going to be lower than 2000

Question 25

What is the main workhorse drug in regards to RA?

Answer 25

METHOTREXATE - at much lower doses than chemotherapy

Question 26

How does leflunomide (Arava) work?

Answer 26

Inhibiting pyrimidine synthesis leading to reduction of lymphocytes.

Question 27

How does hydroxychloroquine (Plaquenil) work?

Answer 27

It inhibits activity of TLRs and inhibits acidification of lysosomes.

Question 28

How does Azathioprine (Imuran) work?

Answer 28

Purine syntheseis inhibitor - side effect cytopenia and pancreatitis

Question 29

What is another big category of RA treatments?

Answer 29

TNF inhibitors

Question 30

All of these drugs fall under what category?

Answer 30

TNF inhibitors

Question 31

What does Tocilizumab (Actemra) do?

Answer 31

Monoclonal antibody against IL-6. Reducing joint damage and inflammation

Question 32

What drug seems like it would work for RA but doesnt seem to be terribly effective?

Answer 32

Anakinra (Kineret) - IL-1 antagonist

Question 33

What does abatacept do?

Answer 33

Binds to CD80/86 on APCs blocking their interaction with APCs

Question 34

What is Rituximab?

Answer 34

Monoclonal antibody against CD20 - depletes B cells

Question 35

What is the role of Tofacitinib (Xeljanz)?

Answer 35

It inhibits JAK enzymes

Question 36

Answer

Answer 36

C - Rituximab - monoclonal antibody against B cells leading to depletion

Question 37

Answer

Answer 37

C - Diagnose with osteoarthritis and start tylenol. There is DIP involvement and Joint abnormalities bone formation.

Question 38

What is wrong with this image?

Answer 38

Everything

Question 39

Does Tanner like football?

Answer 39

Probably, who knows

Question 40

A man you should never trust is a man who does crossfit.

Answer 40

https://www.instagram.com/p/0VZQ1BOa0Nu2O3pdeeyJ4x9cqlwLkHjWPisps0/?taken-by=msanderson44

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