Rheumatology Flashcards
Leflunomide used for?
Several adverse effects, what are they?
Which of the following factor is unlikely to increase the risk of an adverse reaction with Leflunomide?
Concurrent use with methotrexate
pregnancy
Increased alcohol consumption
low body weight
Use of triphasic oral contraceptives
Use = immunosuppressive drug for patients with rheumatoid or psoriatic arthritis.
Adverse effects = Diarrhoea, mouth ulcers and skin rash.
No risk increase = OCP
Leflunomide
Reversal agent in toxicity?
Reversal - cholestyramine
What is the best method of distinguishing between primary and secondary Raynaud’s?
What will show up for primary Raynauds on that test?
Presence of pitting ulcers on finger pulps
Raised ESR
ENA positivity
ANA positivity
Nailfold capillaroscopy
Nailfold capillaroscopy
Primary = normal
Which of the following serum markers have the strongest association with disease activity in both giant cell arteritis (GCA) and polymyalgia rheumatica (PMR)?
Which monoclonal antibody is used for this indication?
CCL11 and IL-10
BAFF and IL-10
CXCL-9 and IL-6
BAFF and IL-6
Serum markers = BAFF and IL-6
Monoclonal = Sarilumab
What is Secukinumab mechanism of action?
What disease is it used for ?
Mechanism = Anti–interleukin-17A monoclonal antibody
Disease = Ankylosing Spondylitis
Is Febuxostat weaker or stronger than Allopurinol?
Which one is safe post myocardial infarction?
Febuxostat is considered more potent than allopurinol in inhibiting the production of uric acid
Inhibition of both the reduced and oxidized forms of xanthine oxidase = more effective and potent inhibitor of uric acid synthesis.
Which of the following clinical findings would NOT be in keeping with the diagnosis of dermatomyositis?
Shawl sign
Periungal changes
Gottron’s papule
Raynaud’s phenomenon.
Heliotrope rash
Raynaud’s phenomenon is NOT common in dermatomyositis
What is the most common acquired muscle disease in adults of the following options:
Inclusion body myositis
Dermatomyositis
Polymyositis
What is the usual presentation of this?
Most common = inclusion body myositis
slow, progressive, asymmetric muscle weakness, often more pronounced in distal muscles.
Serum CK levels may be normal or only mildly elevated
What is the percentage of RF positivity in the general population?
What types of cryoglobulinemia are RF positive?
What non-rheumatic disorders are associated with RF?
4%
Cryo = Type II and III
Non-rheum = Hep b/c, Sarcoid, Primary biliary cholangitis
What are 3 of the most common seronegative spondyloarthropathies:
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
Which of the following radiologic features is NOT typical of RA?
Juxta-articular osteoporosis
Marginal erosions
Joint space narrowing
Periarticular soft tissue swelling
Asymmetric involvement
Asymmetrical involvement
Which of the following DMARDs is LEAST likely to slow the radiographic progression of RA?
Which one is MOST likely?
Which one is most likely to cause ocular damage?
Abatacept
Methotrexate
Prednisone
Hydroxychloroquine
Sulfasalazine
Least = Prednisolone
Most = Methotrexate
Ocular = Hydroxychloroquine
Which of the following is the most useful test for assessment of disease activity in systemic lupus erythematosus?
Why?
Complement factor 3 (C3).
Anti-nuclear antibody (ANA).
C-reactive protein (CRP).
Extractable nuclear antigen antibodies (ENA).
Haemoglobin (Hb).
C3 = Consumption of complement components due to ongoing immune complex formation and deposition, which is a hallmark of the disease’s pathophysiology.
What are 3 organs that are involved IgG4 disease?
Parotid gland
Pancreatitis
Biliary tree (cholangitis)
What manifestation is Methotrexate most useful for in psoriatic arthritis?
What about TNF inhibitor treatment (Infliximab, Etanercept)?
When is an IL-17 inhibitor (Secukinumab) used over TNF-alpha?
MTX = skin
TNF = axial disease
IL-17 = severe skin disease
