Clinical Conference Autoimmunity

Question 1

Criteria for diagnosis of rheumatoid arthritis

Answer 1

4 of the below (crtieria 1-4 for at least 6 weeks). 1) Morning stiffness gt 1 hr, 2) Arthritis of 3 or more joint areas, 3) Arthritis of hand joints, 4) Symmetric arthritis, 5) Rheumatoid nodules, 6) Positive serum rheumatoid factor, 7) Radiographic changes

Question 2

What is rheumatoid factor?

Answer 2

An IgM autoantibody that reacts with a sequence in the Fc region of IgG. Present in most RA patients

Question 3

What condition often leads to a temporary remission of rheumatoid arthritis symptoms?

Answer 3

Pregnancy

Question 4

What probably causes pregnancy-related remission in RA patients?

Answer 4

Increased production of Th2 and decreased production of Th1 cytokines

Question 5

Synovial depositions seen in RA have what components and what hypersensitivity types are these related to?

Answer 5

Autoreactive T-cells (Type IV hypersensitivity) and RF immune complexes (Type III hypersensitivity)

Question 6

What can IL-1 activate which leads to cartilage damage in RA?

Answer 6

Metalloproteinases

Question 7

What is the shared epitope of RA?

Answer 7

The peptide sequence specified by DRB1*0401, an allele shared by almost all RA pts

Question 8

What does Plaquenil do and what is it used for?

Answer 8

Initially an anti-malarial drug, now also used for RA. Disrupts MTs in APCs

Question 9

Which drug for RA should not be used during pregnancy and how does it work?

Answer 9

Methotrexate. Is a potent immunosuppressive drug

Question 10

What do Etanercept and Infliximab target and what are they used to treat?

Answer 10

Treat RA, they target TNFa. Etanercept is a soluble TNF receptor, Infliximab is a humanized antibody to TNF

Question 11

What does Anakinra (Kineret) target and what is it used to treat?

Answer 11

Treat RA, targets IL-1B (prevents it from attaching to cellular receptors)