L05: Rheumatoid Arthritis

Question 1

What is rheumatoid arthritis

Answer 1

Inflammation of the synovial joint

Question 2

What joints are involved in rheumatoid arthritis

Answer 2

Small joints

Question 3

Does rheumatoid arthritis prevent symmetrically or unsymmetrical

Answer 3

Symmetrical

Question 4

What are the symptoms of ra

Answer 4

Pain
Swelling
Stiffness

Question 5

When does the stiffness in ra present

Answer 5

Morning for an hour and stiffness with rest

Question 6

What are the other deformities of ra

Answer 6

MCP joint subluxation
Ulnar deviation
Boutonnière deformity 
Swan neck deformity
Z thumb

Question 7

What can happen if the inflammation in the synovial joint spills out of the joints

Answer 7

Extra-articular damage to cause osteoporosis

Question 8

What are the differential diagnosis for rheumatoid arthritis

Answer 8

Psoriatic arthritis
SLE
Post viral arthritis

Question 9

What blood tests can be done to investigate RA

Answer 9

Inflammatory markers: CRP, ESR

Autoantibodies: rheumatoid factors, anti CCP antibody (highly specific for RA)

Question 10

What imaging can be used to investigate ra

Answer 10

Plain radiographs

Ultrasound/mri

Question 11

What classification criteria is used for ra and how many points are needed for diagnosis

Answer 11

At least 6 points

Question 12

How is ra managed

Answer 12

Pain: Analgesic, NSAIDs
Stop smoking
Physiotherapy
Occupational therapy

Question 13

What is the main drug given to people with ra

Answer 13

Methotrexate (main drug but is teratogenic)
Hydrocychloroquine (alternative for mild disease)
Short term glucocorticoid up to 3 months

Question 14

Which cells are involved in driving the inflammation in RA

Answer 14

T cells
B cells
Neutrophils
Macrophages
Osteoclasts
Fibroblasts

Question 15

Which cytokines activate immune cells

Answer 15

TNF alpha

Interleukin 6

Question 16

Where do cytokines bind to on the immune cells

Answer 16

Receptors

Question 17

How can we have a targeted treatment against ra

Answer 17

By targeting cytokines are blocking the receptor so the cytokines cant bind

Question 18

Give examples of treatment that works to bind to TNF alpha

Answer 18

Adalimumab
Certrolizumab
Golimumab
Infliximab

These are monoclonal antibodies

Question 19

Name a drug that binds to TNF alpha receptors to stop TNF alpha from binding

Answer 19

Etanercept

Question 20

Name a drug that binds to IL6 receptor to stop il6 from binding

Answer 20

Tocizilzumab

Sarilumab

Question 21

How can we target B cells

Answer 21

By targeting cd20 on B cells

Question 22

Which drug can bind to cd20 on B cells

Answer 22

Rituximab

Question 23

How can we target T cells

Answer 23

By blocking cd28 on t cell

Question 24

Name a drug that binds to cd28 on T cell

Answer 24

Abatacept

Question 25

When cytokines bind to its receptors which pathway becomes activated

Answer 25

JAK pathway

Question 26

When Jak protein is activated what does it go onto activate

Answer 26

Stat

Question 27

What drugs can be used in ra to target the Jak pathway

Answer 27

Tofacitninb

Baricitinib

Question 28

When patients are in remission how do we manage them

Answer 28

Step down the therapy by:
Considering glucocorticoid withdrawal
Biological synthetics DMARD

Question 29

When are tnf alpha inhibitors considered for use

Answer 29

When the patient is not responding to at least 2 DMARDs (methotrexate, leflunomide, sulfasalazine, hydroxycholoroquine)