Inflammatory Arthritis

Question 1

What is a rheumatoid factor?

Answer 1

This is a protein which is produced by your immune system which can ATTACK healthy tissue too.

Question 2

What substance levels increases during inflammation?

Answer 2

ESR = Erthyocyte Sedation Rate
CRP = C - Reactive Protein

Question 3

What does ESR measure?

Answer 3

The degree of inflammation in the joints.

Question 4

What does seropositive mean?

Answer 4

Antibodies which are present in the blood which can help with identifying the disease.

Question 5

What antibodies are released during the inflammation process ?

Answer 5

Anti - CCP

RF (rheumatoid factor)

Question 6

How does synovial joint inflammation occur?

Answer 6

This is when the synovium membrane is inflammed due to overuse of the joint. The pain remains in one spot.

Question 7

What is the synovium?

Answer 7

This is connective tissue which LINES the inside of thee joint capsule.

Question 8

How much of the population does RA affect?

Answer 8

0.5 - 1% of the population.

Question 9

How does cartilage destruction occur?

Answer 9

Occurs due to enzymatic action and granulation tissue.

This is known as FOCAL BONE EROSIONS.

Question 10

What is ligament laxity?

Answer 10

This is when the ligaments are loose.

Question 11

What does periarticular osteoporosis mean?

Answer 11

This is past inflammation around a certain joint.

Question 12

Why is there an increase in synovial fluid?

Answer 12

Increased release of prostaglandins and leukotrienes.

Question 13

What are the risk factors of rheumatoid arthritis?

Answer 13

Genetics
Gender = more common in women
Lifestyle = smoking // overweight
Infection

Question 14

Why is smoking such a big issue in causing rheumatoid arthritis?

Answer 14

Causes loss of bone density FASTER.

Question 15

What does the ACR // EULAR panel do?

Answer 15

Create criteria for determining arthritis.

Question 16

What are the 4 main domains used in determining rheumatoid arthritis?

Answer 16

Joint Involvement
Duration of synovitis
Acute phase reactants
Serology

Question 17

What does joint involvement mean in terms of domain 1?

Answer 17

Analyses the large // medium // small joints.

Analyses the number of joints.

Question 18

What does duration of synovitis mean in terms of domain 2?

Answer 18

Usually 3 -6 months of synovitis means that they are a definite sufferer of rheumatoid arthritis.

Question 19

What does acute phase reactants mean in terms of domain 3?

Answer 19

C - reactive protein and Erythrocyte sedimentation rate are inflammatory markers.
They are important mediators in the inflammatory process.

Question 20

What does serology mean in terms of domain 4?

Answer 20

It is the study of blood serum.

Analysis of rheumatoid factors alongside anti - citrullinated protein antibody.

Question 21

What are the current tests available in the clinic for RA?

Answer 21

Rheumatoid factor
Anti - CCP antibodes 
ESR
CRP
DAS scores
Ultrasound // MRI // X - Rays

Question 22

What is DAS?

Answer 22

Disease Activity Score - Rates the pain alongside tender joints and swollen levels.
Out of 28 due to 28 joints being assessed.
Score ranges from 2.0 to 10.0

Question 23

What is the ‘safe’ score for DAS?

Answer 23

< 2.6 indicates remission.

Question 24

Which 2 substances in high quantity determine you have a severe case of RA?

Answer 24

Rheumatoid Factor

Anti - CCP antibodies.

Question 25

When a patient is in pain but breastfeeding too - what would the first treatment of choice be?

Answer 25

Ibuprofen // Diclofenac

Question 26

Give some examples of NSAIDS - non cox 2 selective ones.

Answer 26

``` Ibuprofen Naproxen Diclofenac Indomethacin Piroxicam ```

Question 27

Give some examples of NSAIDS - non cox 1 selective ones.

Answer 27

Celecoxib | Meloxicam

Question 28

Why is non cox - 2 selective ones better?

Answer 28

These are the MOST efficacious.

Question 29

What is used alongside cox - 2 inhibitor to ensure it is cost - effective?

Answer 29

Proton Pump - Inhibitor

Question 30

What happens when Cox - 2 pathways are targeted?

Answer 30

Anti - Inflammatory effects WITHOUT the GI side effects. | Leads to MORE thrombo - embolic events.

Question 31

What class of drugs is told to be avoided for patients at a higher risk of cardiac events?

Answer 31

Coxibs.

Question 32

What is the main cause of GI morbidity with NSAIDS?

Answer 32

Gastric Erosions // Ulcer

Question 33

What are the two main areas in the body where adverse effects of NSAIDS are felt?

Answer 33

GI tract | Renal

Question 34

What are the adverse effects experienced by NSAIDS in the GI tract?

Answer 34

Dyspepsia = Indigestion Nausea Vomiting Haemorrhage

Question 35

What are the adverse effects experienced by NSAIDS in the renal area?

Answer 35

Renal Failure Nephritis Nephrotoxicity

Question 36

What is the main cause of adverse effects experienced by GI tract?

Answer 36

Increase mucosal blood flow | Inhibit gastric acid secretion

Question 37

What is the main cause of adverse effects experienced by the renal system?

Answer 37

Decreased creatinine clearance Mediated vasodilation of renal medulla // glomeruli Inhibition of prostaglandins and prostacyclin

Question 38

What are the other side effects of NSAIDS?

Answer 38

Bronchospasm Skin Rash Allergic reactions

Question 39

What is bronchospasm?

Answer 39

This is the SUDDEN contraction of the muscles in the walls of the bronchioles.

Question 40

What are the causes of other side effects of NSAIDS?

Answer 40

Hypersensitivity

Question 41

What is the name given to an x-ray where there is NO joint space?

Answer 41

Pencil and Cut deformity.

Question 42

What is the purpose of corticosteroids?

Answer 42

They try to control and relieve inflammation EARLIER on in the diagnosis of the disease.

Question 43

What is given as a follow - up medication if corticosteroids do not relieve the pain?

Answer 43

Methotrexate.

Question 44

What form of medication is methotrexate?

Answer 44

It is a DMARD = disease - modifying anti - rheumatic drugs.

Question 45

What is monotherapy?

Answer 45

This is when only ONE DMARD is used.

Question 46

What is combination therapy?

Answer 46

This is when 2 // more therapies are used together in order to give BETTER results.

Question 47

What pathways does DMARDS inhibit?

Answer 47

Inhibits quite important pathways in the body. | They inhibit the pyrimidine and purine metabolism.

Question 48

What is the purpose of leflunomide?

Answer 48

It is a clinically used pyrimidine inhibitor.

Question 49

What is the purpose of the drugs cyclosporin and tacrolimus?

Answer 49

This a drug used to deal with transplant rejection.

Question 50

Name some examples of DMARDS.

Answer 50

Methotrexate Azathioprine Sulphasalazine

Question 51

What is the mechanism of action of methotrexate?

Answer 51

INHIBITS the dihydrofolate reductase

Question 52

What are the adverse effects of methotrexate?

Answer 52

Bone Marrow toxicity Hepatic toxicity Pulmonary involvement Mouth ulcers

Question 53

What do the drugs: 'Anti - TNFa therapies // rituximab // t - cell modulators' have in common?

Answer 53

They are all biological treatments = used for high disease activity. However, they can be mentally debilitating on patients.

Question 54

What is the purpose of the Tumour Necrosis Factor?

Answer 54

Drives the inflammatory pathway. It blocks the co-factors from being produced. It's also LESS likely to be rejected by the body.

Question 55

What drug in combination with TNF produces effective results?

Answer 55

Methotrexate

Question 56

What are the 3 anti - TNF (alpha) drugs widely available?

Answer 56

Infliximab Ethanercept Adalimumab