Rheumatology

Question 1

Biologic DMARDS for management of RA

Answer 1

anti-TNF: etanercept, infliximab, adalimumab, certolizumab, golimumab
IL-1R antagonist: anakinra( il-1 response to inflammatory stimuli and mediate various physiologic responses, including inflammatory and immulogical reactions, il-1 additionally stimulates bone resorption and induce tissue damage.
CTLA4-Ig: abatacept
anti-CD20: rituximab
IL-6R ab: tocilizumab
never use 2 biologics concurrently

Question 2

investigations used to assess the activity of rheumatoid arthritis

Answer 2

1. ESR or CRP- differential diagnosis of a raised ESR in rheumatoid arthritis includes: a. active disease, b. amyloidosis, c, infection d. Sjogren’s syndorme
2. haemoglobin measurement - the severity of normaochronic anaemia usualy correlates with activity
3. anti-CC{ and RF titres
4. the presence of progressive erosions on serial x ray films

Question 3

What is Schober’s test

Answer 3

to test lumbar spine mobility
keep feet apart, find the central point of bilateral PsIS, mark 5cm below and 10cm above, keep knee straight and band forward to touch the toes.
normal >5 cm

Question 4

What are risk facotrs for destructive disease in RA

Answer 4

high tire RF or postive anti-CCP
constitutional symptoms
insidious onset
eorsions early on x ray
rheumatoid nodules early
HLA DR-4

Question 5

side effects and before starting check, monitoring of ANti TNF (biologic dMARDS)

Answer 5

before starting:
update immunisation, PAP smear, rude out hep B and C, chest x ray for TB, quanti-FERON-TB gold test, consider HIV, varicella Zoster  antibody, ANA, anti-ds DNA testing
Monitor 6- monthly 
major side effects:
infusion reactions, 
neuropenia
infections
hepatosplenic T cell
lymphoma 
demyelinating disease
heart failure
skin rashes
probably safe in pregnancy

Question 6

Role of IVIG

Answer 6

IVIG has immunomodulatory action.
IVIG contains idiotypes that neutralize different autoantibodies.
IVIG blocks the Fc receptors on the surface of B-cells and macrophages.
IVIG inhibits inflammatory mediators, such as cytokines, chemokines, and metalloproteinases.
IVIG neutralizes toxins.
IVIG reduces immune complexes.
Substitutive treatment in immune deficiencies.
Alternative treatment, for example, in cases where all other immunosuppressive therapeutic modalities have shown to be inefficient (ultima ratio).