ARTHRITIS & ARTHRITIDIS 1.2

Question 1

What triggers the immune system in rheumatoid arthritis (RA)?

Answer 1

Microbial infection (such as EBV)

Question 2

What receptors recognize microbial infection in RA?

Answer 2

Toll-like receptors (TLR)

Question 3

What is the result of Toll-like receptor activation in RA?

Answer 3

Upregulation of proinflammatory cytokines leading to synovial lining inflammation

Question 4

What characterizes the preclinical stage of RA?

Answer 4

Breakdown in self-tolerance leading to activation of autoantibodies

Question 5

What environmental factors can trigger RA?

Answer 5

Smoking

Question 6

Which autoantibodies can be present years before RA symptoms appear?

Answer 6

Rheumatoid factor (RF) and anti-CCP antibodies

Question 7

What is the role of citrullination in RA?

Answer 7

Citrullination of cellular proteins induces self-reactivity leading to immune complex formation

Question 8

What are the primary criteria for diagnosing RA?

Answer 8

Signs and symptoms of chronic inflammatory arthritis

Question 9

What imaging modality is best for early detection of RA bone abnormalities?

Answer 9

MRI

Question 10

What is the earliest radiographic sign of RA?

Answer 10

Periarticular osteopenia

Question 11

What cell type predominates in the synovial fluid of RA patients?

Answer 11

Neutrophils

Question 12

What is the pathognomonic lab test for RA?

Answer 12

Positive anti-CCP antibody

Question 13

What inflammatory markers are elevated in RA?

Answer 13

ESR

Question 14

What is the usual white blood cell (WBC) count in synovial fluid of RA patients?

Answer 14

5000 to 50 000 WBC/uL

Question 15

Which imaging modality is most sensitive for detecting early bone erosion in RA?

Answer 15

MRI

Question 16

What is the significance of power Doppler ultrasound in RA?

Answer 16

It detects synovitis and increased joint vascularity

Question 17

What is the most common cause of death in RA patients?

Answer 17

Ischemic heart disease

Question 18

What is the median reduction in life expectancy for men and women with RA?

Answer 18

7 years for men. 3 years for women

Question 19

What factor increases the risk of extra-articular manifestations in RA?

Answer 19

Early onset of RA (<25 years old)

Question 20

What percentage of RA patients experience spontaneous remission within 6 months?

Answer 20

0.1

Question 21

What treatment is considered the DMARD of choice for RA?

Answer 21

Methotrexate

Question 22

Why is folic acid given alongside methotrexate?

Answer 22

To counteract the hematologic side effects of methotrexate

Question 23

What is the primary function of nonsteroidal anti-inflammatory drugs (NSAIDs) in RA?

Answer 23

Symptom relief (analgesic and anti-inflammatory)

Question 24

What is the role of glucocorticoids in RA treatment?

Answer 24

Rapid disease control before DMARDs become effective

Question 25

What test should be performed before administering high-dose glucocorticoids?

Answer 25

Infectious Disease Clearance

Question 26

What is the most serious long-term complication of glucocorticoid use?

Answer 26

Osteoporosis

Question 27

What are examples of conventional DMARDs used in RA?

Answer 27

Hydroxychloroquine. sulfasalazine. methotrexate. leflunomide

Question 28

Which DMARD is contraindicated in reproductive-age females?

Answer 28

Methotrexate

Question 29

What class of drugs includes TNF inhibitors for RA?

Answer 29

Biologic DMARDs

Question 30

Why are biologic DMARDs contraindicated in active infections?

Answer 30

They suppress the immune system

Question 31

What condition contraindicates TNF inhibitors in RA?

Answer 31

Chronic hepatitis B infection or class III/IV congestive heart failure

Question 32

What is the mechanism of action of Anakinra in RA?

Answer 32

IL-1 receptor antagonist

Question 33

What does Abatacept target in RA?

Answer 33

CD28-CD80/86 interaction to inhibit T cell co-stimulation

Question 34

What is the target of Rituximab in RA?

Answer 34

CD20 on B lymphocytes

Question 35

What does Tocilizumab target in RA?

Answer 35

IL-6 receptor

Question 36

What drug class does Tofacitinib belong to?

Answer 36

Small molecule JAK inhibitor

Question 37

What is the main goal of modern RA treatment strategies?

Answer 37

Decrease disease activity and prevent joint damage

Question 38

Why is early diagnosis and aggressive therapy important in RA?

Answer 38

To prevent joint fusion and disability

Question 39

What is the significance of achieving clinical remission in RA?

Answer 39

It allows patients to regain joint function and return to normal activities

Question 40

What physical therapy is recommended to prevent fractures in RA?

Answer 40

Lower-extremity strengthening and dynamic strength training

Question 41

What assistive device is recommended for RA patients with foot deformities?

Answer 41

Foot orthotics

Question 42

When is surgery indicated in RA?

Answer 42

For infection. gangrene. osteoporosis or severe joint deformities

Question 43

What criteria are used to define remission in RA?

Answer 43

Tender joint count. swollen joint count. CRP and global assessment

Question 44

What is the target score for clinical remission in RA?

Answer 44

Less than 1 for tender/swollen joint count and less than 3.3 for global assessment