Prof Neil McHugh RA

Question 1

Autoimmune disease occur when there is dysregulation of the immune system with loss of ___-_____.

Answer 1

Self-tolerance

Question 2

List some clinical symptoms common to all autoimmune Rheumatic diseases (6)

Answer 2

1) Malaise (general discomfort/unease)
2) Weight loss
3) Arthritis
4) Anaemia of chronic disease
5) Myalgia (pain in muscle)
6) Fatigue

Question 3

RA is based upon the presence of _____ in at least one joint, the absence of an alternative diagnosis better explaining the ___ and achievement of a total score of at least _ (of a possible 10) on the ACR for Classification of RA

Answer 3

Synovitis

6

Question 4

BSR (British Society for Rheumatology) diagnosis of RA states that persistent joint inflammation affecting at least _ joint areas, involvement of the meta___pop______ or meta____sop_____ joints or early morning stiffness of at least __ min duration.

Answer 4

3

metacarpophalangeal

metatarsophalangeal

30

Question 5

RA increases with age until approx __ years of age and decreases thereafter.

Answer 5

75

Question 6

What predisposing factors are associated with RA?

• ______ (virus, bacterium, smoking, periodontitis)
• Genetic (___-DRB1) - MHC Class II gene
• Hormones or hormonal deficiencies e.g more females with RA than males and disease subsides during _____

Answer 6

Environmental

HLA-DRB1 gene (HLA-DR4)

Pregnancy

Question 7

Autoantibodies in RA:

RF (______ ____)
- Antibodies to Fc domain of Ig_

ACPA (Anti-______ protein _____)

Answer 7

Rheumatoid factor
IgG

Anti-Citrullinated protein antigen

Question 8

Citrulline is a ____-______ modification of arginine

Answer 8

Post-translational modification

Question 9

ACPA can be found up to __ years before onset of symptoms in RA

Answer 9

14 years

Question 10

ACPA (Anti-citrullinated protein antibodies) predict ____ and _____ disease

Answer 10

Erosive and Progressive

Question 11

In RA is there symmetrical or asymmetrical swelling in small joints?

Answer 11

Symmetrical

Question 12

Lumps on the knuckles of a RA patients are called what?

Answer 12

Rheumatoid nodules

Question 13

Due to inflammation of the ocular tissues, RA patients are more susceptible to WHAT?

Answer 13

Scleritis/episcleritis

Question 14

What is periarticular osteopenia?

Answer 14

• Bone loss/thinning around joints

Question 15

DAS28 (___ ____ ____ 28) looks at the total number of swollen/painful joints and levels of ESR and ___ and patient score.

The DAS28 score proves a number on a scale from 0 - __ which indicates current activity of the disease.

Answer 15

Disease Activity Score 28

CRP (C reactive protein)

10

Question 16

What does the HAQDI stand for?

It looks at how well patients can perform various actuates e.g grooming, moving, walking, grip etc…

Answer 16

• Health assessment questionnaire

Question 17

Give an example of a common glucocorticoid that is often given to patients with RA either orally or as a local injection.

Answer 17

Prednisolone

Question 18

Rituximab is a B cell depleting monoclonal anti-CD__ antibody.

Complement mediated cell lysis and _ cell apoptosis

Answer 18

anti-CD20

B - cell apoptosis

Question 19

Abatacept is a soluble receptor composed of CTLA-_ and Fc fragment of IgG.

It blocks the interaction of CD80 and CD86 with CD28 on _ cells.

Answer 19

CTLA-4

T