Rheumatoid Arthritis

Question 1

RA is an organ specific autoimmune condition. T/F?

Answer 1

False it is systemic

Question 2

Which genes can predispose rheumatoid arthritis?

Answer 2

HLA-DR1

HLA-DR4

Question 3

What environmental factor can predispose rheumatoid arthritis?

Answer 3

Smoking

Question 4

What is citrullination?

Answer 4

The conversion of an arginine amino acid to a citrulline amino acid

Question 5

Which molecules are commonly modified in rheumatoid arthritis so that they are no longer recognised as self-antigens?

Answer 5

IgG antibodies
Type II collagen
Vimentin

Question 6

In rheumatoid arthritis which cytokines are released by T cells to recruit macrophages?

Answer 6

IL-17

Interferon gamma

Question 7

Which cytokines are secreted by T cells in rheumatoid arthritis to cause synovial cell proliferation?

Answer 7

TNF alpha
IL-1
IL-6

Question 8

What is the name of the thick, swollen synovial membrane if granulation tissue formed in rheumatoid arhtritis?

Answer 8

Pannus

Question 9

What is the pannus, in rheumatoid arthritis, composed of?

Answer 9

Fibroblasts
Inflammatory cells
Myofibroblasts

Question 10

How does the pannus damage cartilage and the underlying bone in rheumatoid arthritis?

Answer 10

Blocks normal route for nutrition
Effects of cytokines on chondrocytes
Activated synovial cells release proteases which break down articular cartilage
Inflammatory cytokines increase RANK expression on T cells to promote bone resorption

Question 11

What is the target of rheumatoid factor?

Answer 11

The constant Fc domain of altered IgG antibodies

Question 12

The complement system is activated by anti-CCP binding to their citrullinated protein targets. T/F?

Answer 12

True

Question 13

In rheumatoid arthritis inflammatory cytokines escape through the blood supply the cause extra-articular problems. Which cytokines promote fever in the brain?

Answer 13

IL-1

IL-6

Question 14

What is the possible effect of rheumatoid arthritis on blood vessels?

Answer 14

Forms atherosclerotic plaques

Question 15

What are rheumatoid nodules?

Answer 15

Bundles of inflammatory cells surrounding an area of necrosis

Question 16

What are the symptoms of rheumatoid arthritis?

Answer 16

Bilateral symmetric pain and swelling of the small joints
Morning stiffness lasting over an hour
General signs of inflammation - fever, malaise, low appetite and weakness

Question 17

What are the three joint presentations of RA?

Answer 17

Swan neck deformity
Boutonniere deformity
Ulnar deviation

Question 18

What blood tests would be done in RA to check for general signs of inflammation?

Answer 18

Erythrocyte sedimentation rate

C reactive protein levels

Question 19

What are the x ray signs of rheumatoid arthritis?

Answer 19

Decrease bone density
Narrowing of the joint space
Soft tissue swelling
Bone erosions

Question 20

List examples of disease modifying anti-rheumatic drugs?

Answer 20

Methotrexate
Leflunomide
Sulfasalazine
Hydrochloroquine

Question 21

How do infliximab and adalimumab work to treat RA?

Answer 21

The bind to and neutralise TNF alpha

Question 22

How does etanercept work to treat RA?

Answer 22

It acts as a decoy receptor for TNF alpha

Question 23

How does abatacept work to treat RA?

Answer 23

Inhibits costimulation of autoantibody producing B cells by T cells

Question 24

How does rituximab work to treat RA?

Answer 24

It inhibits B cells

Question 25

What are the problems with biologics in treating RA?

Answer 25

Partial responses are common
Remission is not often achieved
Risks and costs of therapy is high

Question 26

TMF blocking agents used to treat RA are useful because the also have the effects of…?

Answer 26

Reducing cardiovascular events and systemic inflammation
Improving endothelial function
Reducing vascular stiffness, fibrinogen, homocysteine and lipoproteins
Increasing lipid concentration