Rheumatoid arthritis

Question 1

What is the reduced life-expectancy in RA

Answer 1

7-10 years - CV disease

Question 2

Which alleles confer susceptibility in Anti-CCP positive RA

Answer 2

HLA-DRAB1*01
HLA-DRAB1*04
HLA-DRAB1*15
CTLA4
STAT4

Question 3

Which alleles confer susceptibility in Anti-CCP negative RA

Answer 3

HLA-DRAB103
HLA-DRAB113
IRF5
STAT 4

Question 4

Which environmental risk factor increase risk in lung?

Answer 4

Smoking

Question 5

Which environmental risk factor increase risk in mouth?

Answer 5

Periodontal disease

Question 6

Which environmental risk factor increase risk in GIT?

Answer 6

Microbiome

Question 7

What are Rheumatoid Factors?

Answer 7

Antibodies directed against Fc portion of human IgG

Question 8

What are Anti-CCP antibodies?

Answer 8

Highly specific antibodies against citrullinated proteins that are the hallmarks of the immune response to RA

Question 9

What manifestations are associated with ACPA?

Answer 9

More severe and destructive disease

RA-related interstitial lung disease and CVD

Question 10

Which epigenetic factors interact/trigger?

Answer 10

Synovial fibroblast-like synoviocytes

Question 11

Which are the major cytokines involved in pathogenesis

Answer 11

TNF
IL-17A/F
IL-1
IL-6

Question 12

What signalling factor mediates bone damage?

Answer 12

RANK ligand

Question 13

What are the clinical features?

Answer 13

Asymmetric, insidious onset
Morning stiffness
Small joints first

Question 14

Which joints are typically spared?

Answer 14

DIPs

Question 15

What is Palindromic rheumatism?

Answer 15

Articular pain then swelling and erythema
Symptoms wrose for hours to a few days
Then resolve in reverse sequence

Question 16

What percentage of pt with palindromic rheumatism go onto dev RA?

Answer 16

50%

Question 17

What is more common in elderly?

Answer 17

Stiffness ? synovitis

Question 18

What is RS3PE?

Answer 18

Remitting, seronegative, symmetric synovitis with pitting oedema syndrome

Question 19

What are the clinical and serological features of RS3PE?

Answer 19

Oedema of dorsum of hand or foot (boxing glove appearance)
Tenosynovitis
Seronegative for RF and ACPA

Question 20

What is the underlying concern with RS3PE?

Answer 20

Can be paraneoplastic

Question 21

Which direction does the wrist deviate?

Answer 21

Radially

Question 22

Which direction do the fingers deviate at the MCPs?

Answer 22

Ulnar

Question 23

Which direction do the finger joints go with Swan neck?

Answer 23

PIP herniates in volar direction

Flexion at DIP

Question 24

Which direction do the finger joint go with Boutonniere deformity?

Answer 24

PIP flexion to rupture of extensor tendons
DIP extension

(opposite to swan neck)

Question 25

Which foot joint is effected first in feet?

Answer 25

5th MTP commonly

Question 26

What are the derm manifestations

Answer 26

Rheumatoid nodules Vasculitis Ulcers Neutrophilic dermatosis

Question 27

What are the ophthalmic manifestations

Answer 27

Episcleritis Scleritis Perilimbic ischaemic ulcers Secondary Sjogren's syndrome

Question 28

What are the pulmonary manifestations?

Answer 28

``` Pleuritis Pleural effusions Nodules NSIP/UIP Bronchiectasis ```

Question 29

What are the CV manifestations?

Answer 29

Premature atherosclerosis | Pericarditis, pericardial effusion

Question 30

What are the radiographic characteristics?

Answer 30

``` Periarticular soft tissue swelling Juxta-articular osteoporosis Marginal erosions Joint space narrowing Symmetric involvement Deformities ```

Question 31

What does Power Doppler positivity portend?

Answer 31

Progression to erosive disease

Question 32

When do you consider biological DMARDs?

Answer 32

Active disease after two or more conventional DMARDs for 6 months

Question 33

What is the ACR70 response rate of methotrexate?

Answer 33

20-40%

Question 34

What dose cut off such subcut MTX be considered?

Answer 34

15mg/week

Question 35

What AEs for MTx?

Answer 35

``` Nausea Ulcer Abnormal LFTs Cytopenia Pneumonitis Teratogenicity ```

Question 36

How much EtOH can be consumed without increasing risk of transaminitis?

Answer 36

<14units per week

Question 37

How is methotrexate excreted?

Answer 37

Renally

Question 38

Which medication shouldn't MTx be combined with

Answer 38

Trimethoprim

Question 39

What is hte ACR70 response rate of sulfalazine

Answer 39

8%

Question 40

Common AEs of ssz?

Answer 40

``` Hypersensitivity reaction Nausea Diarrhoea Agranulocytosis Drug-induced lupus Azoospermia ```

Question 41

AE of hydroxychloroquine?

Answer 41

Hyperpigmentation Retinopathy Myopathy and cardiomyopathy

Question 42

What is hte mech of leflunomide?

Answer 42

Inhibit DHODH (dihydroorate dehydrogenase)

Question 43

AE of leflunomide?

Answer 43

``` Diarrhoea (~25%) Hypertension Hypersensitivity LFTs and pneumonitis esp. when w MTx Leukocytopenia Teratogenicity Peripheral neuropathy ```

Question 44

Which biologics inhibitor TNF?

Answer 44

``` Infliximab Etanercept Adalimumab Golimumab Certolizumab ```

Question 45

What is the ACR70 response rate of TNFi

Answer 45

20%

Question 46

Which TNFi is safest in pregnancy?

Answer 46

Certolizumab

Question 47

What relative contraindications are their for TNFi

Answer 47

``` SLE Demyelinating disorder Infections CCF Pregnancy ```

Question 48

TNFi AE

Answer 48

``` Infection Malignancies - skin and lymphoma Demyelinating conditions Lupus-like syndrome Hepatic Dermatologic reaction ```

Question 49

What is the mechanism of abatacept?

Answer 49

CD80 and CD86 inhibitor

Question 50

What is the mech of tocilizumab

Answer 50

IL-6 receptor inhibitor

Question 51

Which biologic effects CRP?

Answer 51

Tocilizumab

Question 52

Which medications are the JAK inhibitors?

Answer 52

Tofacitinib and baricitinib

Question 53

Which infection in particular do you get with JAK inhibitors?

Answer 53

Herpes zoster