Rheumatoid Arthritis

Question 1

Describe RA.

Answer 1

Symmetrical joint involvement. Rheumatoid nodules, vasculitis, ocular inflammation, cardiopulmonary, splenomegaly

Question 2

What are the risk factors for RA?

Answer 2

Genetics, increasing age, females, positive rheumatoid factor, smoking

Question 3

What is the pathophysiology of RA?

Answer 3

Autoimmune disorder that attacks the synovial and connective tissues.

Question 4

What is pannus?

Answer 4

Chronic inflammation results in proliferation of the synovial tissue.
Pannus invades cartilage and bone surface resulting in bone erosion

Question 5

What are the prodromal symptoms of RA?

Answer 5

weakness, low grade fever, loss of appetite, joint pain, fatigue

Question 6

What are the inflammatory markers of RA?

Answer 6

ESR, CRP, RF, anti-CCP

Question 7

Describe the ACR/EULAR criteria.

Answer 7

Help to predict the severity of the disease. score 6 out 10 classifies as definite RA.

Question 8

What is the criteria for complete remission?

Answer 8

Absence of

Symptoms of inflammation, morning stiffness, fatigue, synovitis, progression, elevation of ESR, CRP

Question 9

What are the predictors of a poor response to treatment?

Answer 9

Functional limitations, Positive RF, ACPA antibodies, radiographic evidence of bony erosions

Question 10

What immunizations do RA patients need to get?

Answer 10

Annual Flu, pneumococcal prior (5yrs)

Question 11

When are NSAIDS, COX2 inhibitors used?

Answer 11

Early relief or adjunct to DMARD

Question 12

When are corticosteroids used?

Answer 12

Adjunct until DMARD begin working.

Question 13

When should DMARD treatment begin?

Answer 13

Within 3 months of patient with established diagnosis of RA.

Question 14

What is the standard DMARD?

Answer 14

Methotrexate (Rheumatrex)

Question 15

When taking Rheumatrex what should be also given?

Answer 15

Folic acid supplements

Question 16

What are the monitoring parameters for Methotrexate?

Answer 16

CBC,LFT monthly x 6 months

Question 17

What drug inhibits pyrimidine synthesis?

Answer 17

Leflunomide (Arava)

Question 18

What drug is an antimalarial that inhibits t-cells and b-cells?

Answer 18

Hydroxychloroquine (Plaquenil)

Question 19

What drug is associated with retinal toxicity?

Answer 19

Hydroxychloroquine (Plaquenil)

Question 20

What drug suppresses pro-inflammatory cytokines, it is a prodrug?

Answer 20

sulfasalazine (Azulfidine)

Question 21

What drug should be avoided with a sulfa allergy?

Answer 21

Sulfasalazine (Azulfidine)

Question 22

What drug can be used for pregnant patients?

Answer 22

Sulfasalazine (azulfidine)

Question 23

Which drug is an tetracycline antibiotic used for RA?

Answer 23

Minocycline

Question 24

What drug inhibits phagocytosis and lysosomal enzyme activity?

Answer 24

Gold, delayed onset of 3-6months

Question 25

What drug is a purine analog and takes 1-3months before onset?

Answer 25

Azathioprine (Imuran)

Question 26

This drug is associated with nephrotoxicity and has a delayed onset of 1-3months.

Answer 26

Cyclosporine

Question 27

What risk is assoicated with the biologic response modifiers?

Answer 27

Risk of infections,

TB screening

Question 28

Which TNF-antagonists can be administered at home?

Answer 28

Etanercept (Enbrel)
Adalimumab (humira)
Golimumab (simponi)
Certolizumab (Cimzia)

Question 29

Which TNF-antagonist is administered in the physician’s office?

Answer 29

Infliximab (Remicade)

Question 30

Which drug is an IL-1 antagonist?

Answer 30

Anakinra (Kineret)

Patient administered

Question 31

What drug is an anti-CD20?

Answer 31

Rituximab (Rotuxan)
Used with methotrexate
Infusion

Question 32

What drug is a selective co-stimulation modulator?

Answer 32

Abatacept (Orencia)

Physician’s office

Question 33

What drug binds to IL-6 receptor?

Answer 33

tocilizumab (Actemra)

Infusion

Question 34

What drug is a janus kinase inhibitor?

Answer 34

Tofacitinib (Xeljanz)