RA and RA drugs

Question 1

2 types of Synovial cells

Answer 1

• Fibroblastlike synovial cells
  
  • Macrophagelike synovial cells

Question 2

Pannus

Answer 2

thickened synovial tissues, invades the bone and acts like a localized tumour

Question 3

Genetic factor of RA

Answer 3

human leukocyte antigen (HLA)

Question 4

Rheumatoid factors (RFs)

Answer 4

• Altered antibodies: IgM and IgG

Question 5

RA process

Answer 5

Arginine –> citruline
T cells express RANKL, promotes osteoclast formation and causes bony erosion

1. Neutrophils activation, degrading the surface layer of articular cartilage
2. Inflammatory cytokines, TNF-a, IL-1B, IL-6, IL-7, IL-21induce enzymatic breakdown of cartilage and bone
3. T cell interact with SFs through THF-a, converting synovium into pannus.

Question 6

specific serum marker for RA

Answer 6

anticitrullinated protein antibody (ACPA)

Question 7

Classes of Antiarthritic Drugs

Answer 7

• NSAIDs
  
  • Glucocorticoids
  • Disease-modifying antirheumatic drugs (DMARDs)
    ○ Traditional DMARDs
    § E.g. Methotrexate, cyclosporine, Imuran
    ○ Biological DMARDs
    § E.g. Adalimumab (Humira), Rituximab
    ○ Targeted DMARDs
    § E.g. Baricitinib

Question 8

Glucocorticoid receptors are located ______ the cell rather than _____cell surface

Answer 8

Glucocorticoid receptors are located inside the cell rather than on cell surface

Question 9

Side Effects of glucocorticoid

Answer 9

• Osteoporosis (systemic glucocortioid therapy)
  
  • Infection
  • Impaired Wound healing
  • Hyperglycemia
  • Myopathy
  • Fluid and electrolyte disturbance
  • Growth delay
  • Psychologic Disturbances: insomnia, anxiety
  • Cataracts and glaucoma
  • Peptic Ulcer Disease
  • Iatrogenic Cushing Syndrome
    Adrenal Suppression (over 3 weeks)

Question 10

DI of glucocorticoids

Answer 10

• Potassium loss
  
  • NSAIDs: increase risk of GI bleed
  • Insulin and oral hypoglycemic
  • Vaccine: immunosuppressant action of glucocorticoids
  • Contraindicated for patients with systemic fungal infection and those receiving live virus vaccines.

Question 11

COX1

Answer 11

“good”
- housekeeping in all tissues
- Mediate beneficial processes
- Inhibit COX1 results in harmful effects:
○ GI ulceration
○ Bleeding
○ Renal impairment

Question 12

COX2: “bad”

Answer 12

• injured tissues
  
  • Mediate harmful processes
  • Inhibit COX2 results in beneficial effects:
    ○ Suppression of inflammation
    ○ Alleviation of pain
    ○ Reduction of fever
    ○ Protection against colorectal CA
  • Harmful effects of COX2 inhibition:
    ○ Renal impairment
    ○ Promotion of MI and stroke

Question 13

Aspirin (ASA)

Answer 13

Nonselective inhibitor of COX, irreversible inhibitor (all other NSAIDs are reversible/competitive inhibitors)