p.52
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the shawl sign?
A red/purple rash over the shoulders, upper back, and neck, resembling a shawl draped over these areas.
p.38
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the clinical features of systemic lupus erythematosus (SLE)?
Common features include fatigue, joint pain, skin rashes, and organ involvement.
p.51
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What does myositis refer to?
A group of inflammatory muscle diseases characterized by muscle inflammation leading to muscle weakness.
p.32
Vaccination Guidelines for Autoimmune Patients
What does MMR stand for?
Measles, Mumps, and Rubella vaccine.
p.54
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the initial diagnostic steps for assessing inflammatory conditions?
Check inflammatory markers including CBC, acute-phase response, and liver function.
p.40
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
Is skin involvement necessary for a diagnosis of Systemic Lupus?
No, skin involvement is not necessary but often develops.
p.30
Vaccination Guidelines for Autoimmune Patients
What is the recommendation for patients on long-term prednisone regarding non-live attenuated vaccines?
Defer other non-live attenuated vaccines except for the flu vaccine.
p.32
Vaccination Guidelines for Autoimmune Patients
What does ACIP stand for?
Advisory Committee on Immunization Practices.
p.56
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What type of nerve involvement can occur in polyarteritis nodosa?
Peripheral nerve involvement.
p.46
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What are the main characteristics of Paget disease?
Increased bone resorption, disorganized and accelerated bone remodeling by osteoblasts, leading to thick but fragile bone.
p.37
Clinical Presentation and Diagnosis of Rheumatic Diseases
What type of arthritis is Case 2 associated with?
Rheumatoid Arthritis (RA).
p.2
Innate and Adaptive Immune Systems
What are the main types of cells in the adaptive immune system?
B cells (produce antibodies) and T cells (CD4+ helper T cells, CD8+ cytotoxic T cells).
p.46
Clinical Presentation and Diagnosis of Rheumatic Diseases
What radiographic features are associated with Paget disease?
Thickening of cortical and trabecular bone, wedge-shaped (flame sign) lesions, and bowing of the femur or tibia.
p.8
Gout and Pseudogout Pathophysiology
What characterizes chronic tophaceous arthritis?
Repetitive precipitation of urate crystals, chalky deposits, and pannus that destroys underlying cartilage.
p.4
Activation and Role of T Cells and B Cells
What is Signal 2 of B cell activation?
CD40/CD40 ligand binding.
p.8
Gout and Pseudogout Pathophysiology
What are tophi?
Large aggregates of urate crystals.
p.34
Innate and Adaptive Immune Systems
What role do Fas/Fas ligand play in immune tolerance?
They trigger apoptosis in self-reactive cells.
p.17
Clinical Presentation and Diagnosis of Rheumatic Diseases
How does the pain in rheumatoid arthritis respond to activity?
It improves slightly with activity.
p.8
Gout and Pseudogout Pathophysiology
What causes 90% of gout cases?
Inefficient renal excretion of urate rather than overproduction.
p.65
Therapeutic Approaches in Rheumatology
What is the role of glucocorticoids during acute flares?
They provide rapid relief from inflammation and symptoms during acute exacerbations.
p.3
Activation and Role of T Cells and B Cells
What is the role of CD3 in T cell activation?
CD3 is an intracellular signaling component that aids in T cell activation.
p.28
Vaccination Guidelines for Autoimmune Patients
What is the mechanism of action of toxoid vaccines?
Inactivated exotoxins induce neutralizing Ig and require adjuvants to increase reactivity.
p.15
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are some extra-articular symptoms that can indicate a rheumatic diagnosis?
Fever, skin rashes, nodules, eye involvement, mouth ulcers, Raynaud’s phenomenon, pulmonary symptoms, cardiovascular issues, neurological symptoms, and kidney involvement.
p.24
Therapeutic Approaches in Rheumatology
What is a key consideration regarding glucosamine in rheumatoid arthritis treatment?
Glucosamine does not reduce inflammation and is not useful in RA.
p.41
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a renal criterion for SLE?
Proteinuria or cellular casts.
p.48
Clinical Presentation and Diagnosis of Rheumatic Diseases
What lab finding is associated with Paget's disease?
Elevated serum alkaline phosphatase (ALP).
p.49
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is sarcoid myositis?
A rare form of sarcoidosis where granulomas involve skeletal muscles, leading to inflammation and damage.
p.30
Vaccination Guidelines for Autoimmune Patients
What should be done with methotrexate after receiving the influenza vaccine?
Hold methotrexate for 2 weeks after vaccination.
p.49
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the clinical features of sarcoidosis?
Enlarged hilar lymph nodes and a reticulated pattern in joints (less common).
p.55
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a key diagnostic step for Takayasu arteritis?
Check blood pressure in both arms.
p.9
Gout and Pseudogout Pathophysiology
What are gouty tophi?
Nodular masses of monosodium urate crystals deposited in the soft tissues of the body.
p.38
Therapeutic Approaches in Rheumatology
What is the type of medication commonly used in the treatment of systemic lupus erythematosus (SLE)?
DMARD (Disease-Modifying Anti-Rheumatic Drug).
p.9
Gout and Pseudogout Pathophysiology
What type of crystals are found in gouty tophi?
Monosodium urate crystals.
p.12
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the main characteristic that differentiates arthritis from nonarticular rheumatological disease?
Arthritis primarily involves inflammation of the joints, while nonarticular rheumatological diseases affect other tissues and systems without joint inflammation.
p.10
Gout and Pseudogout Pathophysiology
What is pseudogout also known as?
Familial chondrocalcinosis.
p.32
Vaccination Guidelines for Autoimmune Patients
What is LAIV4?
Live Attenuated Influenza Vaccine, quadrivalent.
p.12
Clinical Presentation and Diagnosis of Rheumatic Diseases
What distinguishes inflammatory arthritis from non-inflammatory arthritis?
Inflammatory arthritis is characterized by joint inflammation, pain, and swelling, while non-inflammatory arthritis typically involves joint pain without significant inflammation.
p.33
Vaccination Guidelines for Autoimmune Patients
What is a potential mechanism underlying vaccine-mediated autoimmunity?
Molecular mimicry, where vaccine antigens resemble self-antigens.
p.37
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What health risks increase during menopause for individuals with RA?
Increased risk of cardiovascular disease.
p.33
Vaccination Guidelines for Autoimmune Patients
How can adjuvants in vaccines contribute to autoimmunity?
By enhancing immune responses that may lead to self-reactivity.
p.32
Vaccination Guidelines for Autoimmune Patients
What does VAR stand for?
Varicella (chickenpox) vaccine.
p.37
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What type of arthritis is Case 1 associated with?
Non-inflammatory arthritis, specifically osteoarthritis.
p.33
Vaccination Guidelines for Autoimmune Patients
What role do genetic predispositions play in vaccine-mediated autoimmunity?
Individuals with certain genetic backgrounds may be more susceptible to autoimmune reactions post-vaccination.
p.54
Clinical Presentation and Diagnosis of Rheumatic Diseases
What serology tests are important in diagnosing certain inflammatory conditions?
ANCA tests (proteinase vs. myeloperoxidase).
p.49
Clinical Presentation and Diagnosis of Rheumatic Diseases
What leads to inflammation and damage in sarcoid myositis?
The involvement of granulomas in skeletal muscles.
p.57
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What does WG stand for in the context of autoimmune diseases?
Wegener’s Granulomatosis.
p.57
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What does CSS refer to in autoimmune conditions?
Churg Strauss Syndrome (Eosinophilic granulomatosis with polyangiitis).
p.55
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a characteristic symptom of Takayasu arteritis?
Pulseless disease, indicated by absent pulse and presence of bruits.
p.9
Gout and Pseudogout Pathophysiology
Where are gouty tophi typically deposited?
In the soft tissues of the body.
p.52
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are Gottron’s papules?
Purple lesions on the dorsal part of the hand.
p.51
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What are some types of myositis?
Dermatomyositis, polymyositis, and inclusion body myositis.
p.51
Clinical Presentation and Diagnosis of Rheumatic Diseases
How can you distinguish lupus rash from dermatomyositis?
Lupus spares the nasal labial fold, while dermatomyositis involves it.
p.37
Therapeutic Approaches in Rheumatology
Is Hydroxychloroquine safe during pregnancy and breastfeeding?
Yes, but it should be monitored carefully.
p.39
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What are the characteristics of acute Cutaneous Lupus?
Facial erythema, widespread erythema, bullous lesions, and cheilitis.
p.10
Gout and Pseudogout Pathophysiology
What causes pseudogout?
Accumulation of calcium pyrophosphate crystals in the joints.
p.46
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What type of disorder is Paget disease?
A non-neoplastic disorder of the bone.
p.10
Gout and Pseudogout Pathophysiology
What type of mutation is associated with pseudogout?
Germline mutation in the pyrophosphate transport channel.
p.8
Gout and Pseudogout Pathophysiology
What is gout?
A disorder of purine metabolism characterized by acute attacks of inflammatory arthritis due to urate crystal deposition.
p.40
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What condition resembles psoriasis but worsens with sun exposure?
Systemic Lupus Erythematosus (SLE).
p.43
Innate and Adaptive Immune Systems
What are some common uses of Samarium?
In magnets, lasers, and nuclear reactors.
p.47
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What characterizes Stage I of Paget's disease?
Hot osteolytic stage with large osteoclasts and increased nuclei.
p.20
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
Which gender is more affected by osteoarthritis?
Females are more affected than males.
p.10
Gout and Pseudogout Pathophysiology
How is pseudogout differentiated from gout in laboratory analysis?
By the presence of monosodium urate (MSU) crystals in synovial fluid for gout.
p.4
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What types of autoimmune diseases are associated with autoreactive Th1 or Th17 cells?
Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Psoriasis, Crohn’s disease, and Multiple Sclerosis (MS).
p.43
Innate and Adaptive Immune Systems
Is Samarium naturally occurring?
Yes, it is found in various minerals.
p.52
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the significance of differentiating types of myositis?
It helps in accurate diagnosis and treatment of the condition.
p.37
Vaccination Guidelines for Autoimmune Patients
What is recommended for women using biologics?
They need to be on birth control.
p.46
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are common clinical features of Paget disease?
Asymptomatic, localized bone pain, cranium enlargement, platybasia, pelvic alterations, hearing loss, and high output cardiac failure.
p.58
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is the classic triad of Wegener’s Granulomatosis?
Upper respiratory tract, lungs, and kidneys involvement.
p.17
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the key symptoms of osteoarthritis as described in the vignette?
Dull and aching pain, stiffness after rest lasting less than 30 minutes, and pain relieved by rest and acetaminophen.
p.53
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is vasculitis?
Inflammation in the blood vessel walls that causes vessel narrowing, blockage, aneurysm, or rupture.
p.8
Gout and Pseudogout Pathophysiology
What is gouty nephropathy?
Renal complications arising from urate crystals.
p.34
Inflammatory Mediators and Cytokines
What are the two mechanisms by which allergens and adjuvants work?
They bind to innate receptors (TLRs) to stimulate TNF alpha and induce maturation of dendritic cells, or bind directly to TLR on dendritic cells to trigger maturation.
p.64
Therapeutic Approaches in Rheumatology
What are COX-2 selective NSAIDs?
NSAIDs that specifically inhibit the COX-2 enzyme, such as celecoxib and etoricoxib.
p.50
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are potential cardiac issues in these clinical conditions?
Conduction abnormalities.
p.66
Therapeutic Approaches in Rheumatology
What are the potential adverse effects of cyclosporine?
Adverse effects include nephrotoxicity, hypertension, and increased risk of infections.
p.25
Therapeutic Approaches in Rheumatology
What should be done with bDMARDs before surgery?
They should be withheld before surgery; if missed, wait two weeks to restart.
p.11
Gout and Pseudogout Pathophysiology
What crystals are identified in pseudogout?
Calcium pyrophosphate dihydrate (CPPD) crystals.
p.63
Therapeutic Approaches in Rheumatology
What are common adverse effects (AEs) associated with plaque psoriasis treatments?
Weight loss, depression, and suicidal ideation.
p.22
Clinical Presentation and Diagnosis of Rheumatic Diseases
What physical examination findings are associated with rheumatoid arthritis?
Synovitis, polyarticular joints, involvement of wrist, 2nd, 3rd MCP and MTP joints (hip involvement is rare).
p.59
Gout and Pseudogout Pathophysiology
What are some adverse effects of Allopurinol?
Hypersensitivity reactions, Steven Johnson syndrome, and toxic epidermal necrolysis.
p.7
Gout and Pseudogout Pathophysiology
What crystals are associated with chondrocalcinosis?
Calcium pyrophosphate dihydrate (Ca py) crystals.
p.33
Vaccination Guidelines for Autoimmune Patients
How can the immune system's activation by vaccines lead to autoimmunity?
Vaccines can activate T cells that may cross-react with self-tissues.
p.47
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What is observed in the X-ray during Stage I of Paget's disease?
Cortical thickening and coarse trabeculations.
p.58
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is the defining feature of Churg Strauss Syndrome?
Eosinophilic inflammation.
p.40
Clinical Presentation and Diagnosis of Rheumatic Diseases
What laboratory finding is commonly positive in Systemic Lupus?
Positive ANA (Antinuclear Antibody).
p.53
Clinical Presentation and Diagnosis of Rheumatic Diseases
What can result from the inflammation caused by vasculitis?
Narrowing, blockage, aneurysm, or rupture of blood vessels.
p.65
Therapeutic Approaches in Rheumatology
What strategies can be employed to mitigate risks associated with NSAID use?
Using the lowest effective dose, co-prescribing gastroprotective agents, and regular monitoring of renal function.
p.13
Clinical Presentation and Diagnosis of Rheumatic Diseases
How does the onset of symptoms typically differ between monoarticular and polyarticular arthritis?
Monoarticular arthritis often has sudden onset, while polyarticular arthritis may have a gradual onset.
p.3
Therapeutic Approaches in Rheumatology
How does Etanercept affect TNF alpha?
It binds to TNF alpha, preventing it from interacting with its natural receptors.
p.66
Therapeutic Approaches in Rheumatology
What is the mechanism of action of azathioprine?
Azathioprine is a prodrug that gets converted to 6-mercaptopurine, which inhibits purine synthesis, leading to decreased lymphocyte proliferation.
p.50
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are common skin manifestations in certain clinical conditions?
Plaques on the cheek and nose.
p.64
Therapeutic Approaches in Rheumatology
What are the benefits of COX-2 selective NSAIDs?
They provide anti-inflammatory effects with potentially fewer gastrointestinal side effects.
p.66
Therapeutic Approaches in Rheumatology
How do calcineurin inhibitors like cyclosporine work?
Calcineurin inhibitors block the activation of T cells by inhibiting the phosphatase activity of calcineurin, which is necessary for T cell activation.
p.44
Clinical Presentation and Diagnosis of Rheumatic Diseases
What lab evaluations are used to diagnose SLE?
CBC, chemistries, urine analysis, ANA, dsDNA, ENA, Sjogren’s Abs, phospholipid Abs, and anti-C1q.
p.36
Therapeutic Approaches in Rheumatology
What are some contraindications for using biological agents?
Multiple Sclerosis (MS), optic neuritis, congestive heart failure (CHF).
p.21
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What imaging findings are characteristic of osteoarthritis?
Osteophytes on X-ray and narrowing of joint space.
p.44
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the significance of ANA in SLE diagnosis?
It is sensitive but not specific to SLE.
p.25
Therapeutic Approaches in Rheumatology
What is the 'treat-to-target' approach for RA?
Adjusting therapies to achieve specific, measurable goals like remission or low disease activity.
p.22
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are common symptoms experienced by patients with rheumatoid arthritis?
Pain at rest, limitation of motion, morning stiffness, fatigue.
p.35
Therapeutic Approaches in Rheumatology
What is the role of steroids in rheumatoid arthritis treatment?
Steroids can be used as a bridge, but they reduce long-term life expectancy.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are CCP antibodies and their relevance in RA diagnosis?
CCP antibodies (ACVPA or ACA) are used in the diagnosis of RA.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is the role of Rheumatoid Factor (RF) in RA?
RF is an autoantibody that targets the Fc region of IgG, forming immune complexes that contribute to RA pathogenesis.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What laboratory finding is commonly elevated in polymyositis?
Elevated creatine kinase (CK) levels.
p.20
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What is the typical age group for osteoarthritis onset?
Usually over 50 years old.
p.40
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are some minor symptoms of Systemic Lupus?
Skin rash, arthritis, and minor chest pain.
p.13
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is polyarticular arthritis?
Arthritis that affects multiple joints.
p.19
Clinical Presentation and Diagnosis of Rheumatic Diseases
What type of pain is the patient experiencing in his right shoulder?
Localized, sharp pain that worsens with overhead activities or lying on the affected side.
p.3
Innate and Adaptive Immune Systems
What cells migrate to combat pathogens?
Neutrophils and macrophages.
p.17
Clinical Presentation and Diagnosis of Rheumatic Diseases
What laboratory findings are indicative of rheumatoid arthritis?
Elevated ESR and CRP, positive rheumatoid factor (RF) and anti-CCP antibodies.
p.24
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the significance of ETA protein in rheumatoid arthritis?
ETA protein is a marker used in assessing disease activity.
p.24
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the role of synovial fluid in rheumatoid arthritis?
Synovial fluid analysis helps in evaluating disease activity.
p.64
Therapeutic Approaches in Rheumatology
How do NSAIDs inhibit cyclooxygenase (COX) enzymes?
By blocking the activity of COX enzymes, which reduces the synthesis of prostaglandins.
p.64
Therapeutic Approaches in Rheumatology
What is the impact of NSAIDs on prostaglandin synthesis?
They decrease prostaglandin synthesis, leading to anti-inflammatory and analgesic effects.
p.1
Innate and Adaptive Immune Systems
What is the role of macrophages and dendritic cells in the innate immune response?
They are the first to detect pathogens and can travel to present antigens.
p.7
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What happens to complement levels during SLE disease activity?
Complement levels (e.g., C3, C4) are often low due to consumption.
p.25
Therapeutic Approaches in Rheumatology
What is a common risk associated with NSAIDs in rheumatoid arthritis (RA) treatment?
Heart and renal risks; they do not prevent progression of RA.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What type of crystals are found in joint aspiration for gout?
Needle-shaped monosodium urate crystals with negative birefringence.
p.66
Therapeutic Approaches in Rheumatology
What are the therapeutic indications for tacrolimus?
Tacrolimus is indicated for organ transplantation and severe autoimmune diseases.
p.44
Clinical Presentation and Diagnosis of Rheumatic Diseases
What does a CBC evaluate in SLE diagnosis?
Lymphocytes and platelets.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the key symptoms of Systemic Lupus Erythematosus (SLE) in the case presented?
Fatigue, joint pain, and a butterfly-shaped facial rash.
p.62
Therapeutic Approaches in Rheumatology
What type of drug is Infliximab?
A chimeric monoclonal antibody.
p.15
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
Which gender is more commonly affected by gout?
Men, particularly before age 60.
p.44
Therapeutic Approaches in Rheumatology
What treatments are used for skin involvement in SLE?
Antimalarials, steroids, DMARDs, and biologics.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is citrullination in the context of RA?
A post-translational modification where arginine is converted to citrulline, leading to targeting of citrullinated proteins by the immune system.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the primary symptom of polymyositis?
Progressive muscle weakness, particularly in the shoulders and hips.
p.61
Therapeutic Approaches in Rheumatology
What is the primary action of Teriparatide?
Agonist at PTH1R, stimulating bone growth.
p.35
Therapeutic Approaches in Rheumatology
What are cDMARDs and their effect on immune factors?
cDMARDs like anti-malarial and sulfasalazine do not reduce immune factors.
p.11
Clinical Presentation and Diagnosis of Rheumatic Diseases
How do soft tissue disorders present?
Without redness, swelling, or warmth.
p.11
Clinical Presentation and Diagnosis of Rheumatic Diseases
What symptoms are associated with arthritis?
Swelling, warmth, redness, and pain.
p.46
Clinical Presentation and Diagnosis of Rheumatic Diseases
How does Paget disease affect blood flow?
Blood is shunted from the internal carotid to the bones rather than the brain.
p.2
Complement System in Immune Response
What is the function of C3a in the inflammatory response?
C3a functions as a chemoattractant, recruiting immune cells such as eosinophils and basophils to the site of infection or inflammation.
p.20
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What are the two types of loading that can lead to osteoarthritis?
Excessive load on a normal joint or normal load on a defective joint.
p.65
Therapeutic Approaches in Rheumatology
What should be monitored when using NSAIDs for pain management?
Monitoring for adverse events such as gastrointestinal bleeding, renal impairment, and cardiovascular risks.
p.45
Therapeutic Approaches in Rheumatology
What are biologic DMARDs used for?
To help prevent and treat lupus nephritis (LN).
p.34
Activation and Role of T Cells and B Cells
How does CD40 ligand affect B cells?
It restores proliferation and access to follicles.
p.45
Clinical Presentation and Diagnosis of Rheumatic Diseases
What features are looked for in a renal biopsy?
Proliferative changes, inflammation, and signs of chronicity.
p.3
Activation and Role of T Cells and B Cells
How are CD4+ T cells activated?
When antigen-presenting cells (APCs) present an antigen on MHC class II molecules to the T cell receptor (TCR) on CD4+ T cells, along with co-stimulatory signals.
p.45
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
How can drug-induced lupus be distinguished from regular lupus?
By the presence of Histone Ab and Phospholipid Ab.
p.45
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What medications are commonly associated with drug-induced lupus?
Hydralazine, procainamide, quinidine, chlorpromazine, HMG CoA inhibitors, and isoniazid.
p.21
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What are common symptoms associated with osteoarthritis?
Pain with use, stiffness, and range of motion issues.
p.50
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is cobble stoning in the context of clinical manifestations?
A specific appearance related to certain conditions.
p.50
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the renal manifestations associated with certain diseases?
Hypercalciuria and hypercalcemia.
p.41
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is an immunological criterion for SLE?
Presence of anti-nuclear antibodies (ANA).
p.7
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What antibodies are associated with Rheumatoid Arthritis?
Anti-citrullinated protein antibody (ACPA).
p.15
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a common gender-specific difference in osteoarthritis (OA)?
Women are more likely to develop OA, especially in the knees and hands, and experience more severe symptoms post-menopause.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
At what age do women typically experience Rheumatoid Arthritis (RA) compared to men?
Women often experience RA at an earlier age during their childbearing years.
p.59
Gout and Pseudogout Pathophysiology
What is the mechanism of action of Colchicine?
It binds to tubulin, inhibits phagocytosis, disrupts NLRP3 inflammasome activity, and lowers IL-1B release.
p.7
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What is Eburnation in the context of Osteoarthritis?
Eburnation refers to the narrowing of joint space from reactive bone in areas of cartilage loss.
p.22
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a notable gender-specific issue in osteoarthritis (OA) and rheumatoid arthritis (RA)?
RA has a higher prevalence in females compared to males.
p.59
Gout and Pseudogout Pathophysiology
In which condition should Probenecid be avoided?
In patients with urolithiasis.
p.4
Inflammatory Mediators and Cytokines
How do antibodies participate in the inflammatory response?
Antibodies bind to antigens on pathogens, marking them for destruction (opsonization), neutralizing toxins, and activating the complement system, which enhances inflammation.
p.40
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are some major symptoms of Systemic Lupus?
Organ involvement, psychosis, and bleeding problems.
p.65
Therapeutic Approaches in Rheumatology
Why is it important to individualize NSAID therapy?
Individualizing therapy ensures optimal pain relief while minimizing adverse effects based on patient-specific factors.
p.47
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What prominent feature is seen in Stage III of Paget's disease?
Prominent irregular basophilic cement lines.
p.2
Inflammatory Mediators and Cytokines
What are the initial events leading to an inflammatory response?
1. Injury/Infection: Tissue damage or pathogen invasion. 2. Release of Mediators: Histamine, cytokines, and other mediators are released. 3. Vasodilation: Increased blood flow to the affected area. 4. Increased Permeability: Capillaries become more permeable, allowing immune cells and proteins to enter the tissue.
p.45
Clinical Presentation and Diagnosis of Rheumatic Diseases
When should a renal biopsy be performed?
If there is glomerular hematuria, cellular casts, persistent proteinuria, or unexplained decrease in GFR.
p.53
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a characteristic feature of small vessel vasculitis?
It often presents with skin manifestations and systemic symptoms.
p.34
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the significance of early intervention in rheumatoid arthritis (RA) progression?
Intervening early, within less than 5 years of onset, is crucial for better disease management.
p.66
Therapeutic Approaches in Rheumatology
What are the common adverse effects of mycophenolate mofetil?
Common adverse effects include gastrointestinal disturbances, increased risk of infections, and bone marrow suppression.
p.15
Clinical Presentation and Diagnosis of Rheumatic Diseases
Which condition is associated with fever as an extra-articular symptom?
Systemic lupus erythematosus (SLE), systemic juvenile idiopathic arthritis, and vasculitis.
p.64
Therapeutic Approaches in Rheumatology
What are the risks associated with COX-2 selective NSAIDs?
Increased risk of cardiovascular events.
p.41
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a serological criterion for SLE?
Anti-double-stranded DNA or anti-Smith antibodies.
p.22
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What factors contribute to the development of rheumatoid arthritis?
Genetic predisposition with environmental trigger.
p.66
Therapeutic Approaches in Rheumatology
What are the adverse effects associated with voclosporin?
Adverse effects may include hypertension, nephrotoxicity, and increased risk of infections.
p.60
Gout and Pseudogout Pathophysiology
What is the mechanism of action of Pegloticase?
Uricase catalyzes the oxidation of uric acid to allantoin.
p.7
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What is the process of cartilage injury in Osteoarthritis?
Cartilage injury leads to chondrocyte proliferation, hypertrophic chondrocyte formation, cartilage ossification, and osteophyte development.
p.62
Therapeutic Approaches in Rheumatology
What is the structure of Certolizumab?
A pegylated humanized antigen Fab fragment.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the role of Rheumatoid factor in diagnosing RA?
Rheumatoid factor can indicate RA but is not definitive as it shows up in many other diseases.
p.63
Therapeutic Approaches in Rheumatology
What conditions is Belimumab used to treat?
Systemic lupus erythematosus (SLE) and lupus nephritis.
p.63
Therapeutic Approaches in Rheumatology
What are JAK inhibitors used for?
They are last-resort drugs for various autoimmune conditions.
p.11
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the three sources of rheumatic symptoms?
Soft tissue disorders, arthritis, and bone disorders.
p.44
Therapeutic Approaches in Rheumatology
What are some side effects of steroids in SLE treatment?
Diabetes, hypertension, and osteoporosis.
p.27
Therapeutic Approaches in Rheumatology
How do Fe or Cu affect NTP?
They prevent NTP from folding, which helps prevent calcium buildup.
p.8
Gout and Pseudogout Pathophysiology
What defines hyperuricemia?
Plasma urate levels above 6.8 mg/dl.
p.13
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is monoarticular arthritis?
Arthritis that affects a single joint.
p.54
Therapeutic Approaches in Rheumatology
What is the most effective treatment for medium vessel involvement?
Combination therapy with cyclophosphamide.
p.17
Clinical Presentation and Diagnosis of Rheumatic Diseases
What type of arthritis is characterized by joint pain and swelling in the hands and wrists, bilaterally?
Rheumatoid Arthritis (RA).
p.58
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the classic triad of Henoch Schonlein Purpura?
Palpable purpura, arthritis, glomerulonephritis, and mesenteric ischemia.
p.40
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are some physical findings associated with Systemic Lupus?
Lung rub, fluid in abdomen, and edema in limbs.
p.47
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What development occurs in the sclerotic phase of Paget's disease?
Transition from the mosaic pattern to a more sclerotic appearance.
p.45
Therapeutic Approaches in Rheumatology
What is the role of B cell agents in lupus treatment?
They help prevent and treat lupus nephritis.
p.65
Therapeutic Approaches in Rheumatology
In which conditions are glucocorticoids indicated as bridging therapy?
Conditions like giant cell arteritis and polymyalgia rheumatica.
p.24
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is involved in the process of assessing disease activity in rheumatoid arthritis?
Counting the number of affected joints.
p.1
Innate and Adaptive Immune Systems
Which cells are part of the innate immune system?
Macrophages, neutrophils, dendritic cells, natural killer (NK) cells, eosinophils, basophils.
p.1
Innate and Adaptive Immune Systems
What are PRRs and PAMPS in the context of the innate immune system?
PRRs (Pattern Recognition Receptors) bind to PAMPS (Pathogen-Associated Molecular Patterns) to detect pathogens.
p.25
Therapeutic Approaches in Rheumatology
What are the risks of steroid joint injections?
Flare, irritation, infection, bleeding, hypopigmentation, and diabetes flare.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What type of crystals are found in joint aspiration for pseudogout?
Rhomboid-shaped calcium pyrophosphate crystals with positive birefringence.
p.50
Clinical Presentation and Diagnosis of Rheumatic Diseases
What imaging finding may indicate hilar lymphadenopathy?
Found incidentally on chest x-ray.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
What hormonal changes occur in women after the age of 50 that are related to OA?
Hormonal changes after 50 can contribute to the development of OA in women.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What laboratory findings are indicative of Systemic Lupus Erythematosus?
Positive ANA and anti-dsDNA antibodies, anemia, and mild proteinuria.
p.25
Therapeutic Approaches in Rheumatology
What validated assessments are used in the 'treat-to-target' approach?
DAS28, CDAI, or SDAI scores.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a notable symptom of scleroderma?
Progressive tightening of the skin on hands and face.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
How does smoking influence the risk of developing RA?
Smoking increases risk through higher levels of DNA methylation and induces peptidyl deaminase in alveolar macrophages.
p.11
Gout and Pseudogout Pathophysiology
What are the serum uric acid levels typically like in pseudogout?
Usually normal or not elevated.
p.27
Therapeutic Approaches in Rheumatology
What effect does NTP have on pyrophosphate production?
NTP increases the production of pyrophosphate.
p.61
Therapeutic Approaches in Rheumatology
What is the mechanism of action of Calcitonin?
Inhibits osteoclastic bone resorption.
p.8
Gout and Pseudogout Pathophysiology
What are the manifestations of acute arthritis in gout?
Dense inflammatory infiltrate and long slender needle-shaped urate crystals.
p.47
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What is the hallmark of Stage III of Paget's disease?
Mosaic pattern of lamellar bone.
p.53
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the three categories of vessel size in vasculitis?
Large vessel, medium vessel, and small vessel vasculitis.
p.13
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are some common causes of polyarticular arthritis?
Rheumatoid arthritis, lupus, or psoriatic arthritis.
p.65
Therapeutic Approaches in Rheumatology
What are the anti-inflammatory effects of glucocorticoids?
Glucocorticoids reduce inflammation and suppress the immune response.
p.24
Clinical Presentation and Diagnosis of Rheumatic Diseases
Which scoring system is considered the best for assessing rheumatoid arthritis?
The ACR (American College of Rheumatology) scoring system.
p.34
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is molecular mimicry in the context of autoimmune diseases?
It refers to the similarity between foreign antigens and self-antigens, which can lead to autoimmune responses, as seen in GBS and Schwann cells.
p.64
Therapeutic Approaches in Rheumatology
What are examples of non-selective NSAIDs?
Ibuprofen, naproxen, and diclofenac.
p.24
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What are some extra-articular manifestations of rheumatoid arthritis?
Skin nodules, vasculitis, dry eyes, lung disease, cardiovascular disease, anemia, neuropathy, kidney issues.
p.50
Clinical Presentation and Diagnosis of Rheumatic Diseases
What eye involvement can occur in certain clinical conditions?
Eye involvement can occur.
p.1
Inflammatory Mediators and Cytokines
What are the most important pro-inflammatory cytokines in the innate immune response?
IL-1, IL-6, and TNF-alpha.
p.26
Gout and Pseudogout Pathophysiology
What is the de novo synthesis pathway for purines?
Making purines from scratch, with glutamine as a precursor for adenine and guanine biosynthesis.
p.64
Therapeutic Approaches in Rheumatology
Why is it important to differentiate between non-selective and COX-2 selective NSAIDs?
To tailor treatment based on benefits and risks for rheumatological diseases.
p.66
Therapeutic Approaches in Rheumatology
What is the mechanism of action of mycophenolate mofetil?
Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase, leading to decreased lymphocyte proliferation.
p.26
Gout and Pseudogout Pathophysiology
What effect does high de novo activity have on uric acid concentration?
It increases purine turnover, resulting in higher uric acid concentration.
p.7
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What role do collagenases play in Osteoarthritis?
Collagenases MMP-1,3,9,14 play the most important role in OA.
p.61
Therapeutic Approaches in Rheumatology
What are the main adverse effects (AEs) associated with Romosozumab?
Myocardial infarction (MI), stroke, and cardiovascular death.
p.11
Gout and Pseudogout Pathophysiology
How do CPPD crystals appear under polarized light microscopy?
They exhibit positive birefringence.
p.59
Gout and Pseudogout Pathophysiology
What is Allopurinol used for?
It is used for recurrent gout and hyperuricemia.
p.15
Clinical Presentation and Diagnosis of Rheumatic Diseases
What laboratory studies might be appropriate based on findings of a rheumatic disease?
Blood tests for inflammatory markers, autoantibodies, and imaging studies like X-rays or MRIs.
p.22
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is the gender ratio for rheumatoid arthritis prevalence?
Female to male ratio is 3:1.
p.27
Therapeutic Approaches in Rheumatology
What role does magnesium (Mg) play in the reaction of ATP to AMP?
Mg is needed for the reaction via the enzyme NTP.
p.26
Gout and Pseudogout Pathophysiology
What happens with decreased xanthine dehydrogenase?
High levels of xanthine in urinary excretion, leading to xanthinuria.
p.60
Therapeutic Approaches in Rheumatology
What are the main uses of Alendronate?
Osteoporosis and Paget’s disease.
p.60
Therapeutic Approaches in Rheumatology
What are common adverse effects of Alendronate?
Osteonecrosis of the jaw and esophagitis.
p.33
Vaccination Guidelines for Autoimmune Patients
What is the significance of epitope spreading in vaccine-mediated autoimmunity?
It refers to the process where an immune response to a vaccine leads to the recognition of additional self-antigens.
p.47
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What defines Stage II of Paget's disease?
Mixed osteolytic-osteoblastic phase with osteoclasts eroding bone and deposits of osteoid.
p.65
Therapeutic Approaches in Rheumatology
What are the therapeutic indications of NSAIDs in rheumatological diseases?
NSAIDs are used for pain management and to reduce inflammation in conditions like rheumatoid arthritis and osteoarthritis.
p.34
Innate and Adaptive Immune Systems
What is central tolerance in the immune system?
The process by which self-reactive B cells and T cells are eliminated to prevent autoimmunity.
p.19
Clinical Presentation and Diagnosis of Rheumatic Diseases
How long has the patient been experiencing shoulder pain?
For the past two weeks (acute).
p.3
Innate and Adaptive Immune Systems
What role do TH1 cells play in the immune response against Mycobacterium tuberculosis?
They secrete IFN-γ, activating macrophages to kill intracellular bacteria.
p.1
Innate and Adaptive Immune Systems
What is the primary function of the innate immune system?
Provides the first line of defense with nonspecific responses, including barriers and phagocytic cells.
p.1
Innate and Adaptive Immune Systems
What types of barriers are included in the innate immune system?
Skin and mucous membranes.
p.28
Vaccination Guidelines for Autoimmune Patients
What are the indications for vaccination in autoimmune patients?
Increased risk due to autoimmune disease and medications like glucocorticoids, DMARDs, and biologics.
p.66
Therapeutic Approaches in Rheumatology
What are the therapeutic indications for cyclophosphamide?
Cyclophosphamide is used for severe autoimmune diseases such as systemic lupus erythematosus and vasculitis.
p.24
Therapeutic Approaches in Rheumatology
What are some non-pharmacologic therapies for osteoarthritis and rheumatoid arthritis?
Social support, education, assistive devices, weight reduction, thermal modalities, muscle strengthening.
p.28
Vaccination Guidelines for Autoimmune Patients
What are recombinant protein vaccines composed of?
Select antigens that attach to host cells or virulence, inducing neutralizing and/or opsonizing Ig.
p.28
Vaccination Guidelines for Autoimmune Patients
What is a characteristic of live attenuated vaccines?
Microbes are cultured to lose the ability to cause disease but can still grow in the host.
p.50
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a histological hallmark of certain granulomatous diseases?
Noncaseating epithelioid granuloma.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
Which gender is more affected by Osteoarthritis (OA)?
Females are more affected than males.
p.28
Vaccination Guidelines for Autoimmune Patients
What are the therapeutic uses of vaccines?
To provide immunity against specific diseases, especially in at-risk populations.
p.50
Therapeutic Approaches in Rheumatology
What is the first-line treatment for certain inflammatory conditions?
Steroids (moderate dose).
p.22
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a key histological feature of rheumatoid arthritis?
Cellular infiltration of synovium (no osteophytes).
p.44
Therapeutic Approaches in Rheumatology
What is monitored in SLE management?
CBC, CMP, UA, UPCR, C3 and C4 levels, dsDNA levels, and disease activity indexes.
p.25
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the indications for surgery in patients with symptomatic OA and RA?
Persistent pain despite treatment and physical therapy, loss of joint function, or fracture.
p.61
Therapeutic Approaches in Rheumatology
What are the adverse effects of Denosumab?
Risk of infections, jaw issues, hypocalcemia, and hypophosphatemia.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
Which inflammatory markers are used in the diagnostic testing for RA?
ESR (Erythrocyte Sedimentation Rate) and C-RP (C-Reactive Protein) are used.
p.61
Therapeutic Approaches in Rheumatology
What are the adverse effects associated with Teriparatide?
Hypercalcemia and osteosarcoma.
p.35
Therapeutic Approaches in Rheumatology
What should be avoided when using hydroxychloroquine?
Avoid hydroxychloroquine with retinal disease and low G6PD.
p.10
Gout and Pseudogout Pathophysiology
What is the shape and characteristic of MSU crystals in gout?
Needle-shaped and exhibit negative birefringence under polarized light microscopy.
p.17
Clinical Presentation and Diagnosis of Rheumatic Diseases
What findings were observed in the X-rays of the patient with osteoarthritis?
Joint space narrowing and osteophyte formation.
p.46
Clinical Presentation and Diagnosis of Rheumatic Diseases
What can result from high output cardiac failure in Paget disease?
Increased cardiac input leads to cardiac failure.
p.13
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a common cause of monoarticular arthritis?
Injury or infection in one joint.
p.14
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the physical presentation of a positive Trendelenburg sign?
Dropped pelvis on the normal side and trunk bending towards the involved side.
p.34
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What happens when there are defects in tolerance mechanisms?
It permits expansion of B and T cells, potentially leading to autoimmunity.
p.53
Clinical Presentation and Diagnosis of Rheumatic Diseases
How does medium vessel vasculitis typically affect the body?
It can cause ischemia and organ damage due to blockage.
p.19
Clinical Presentation and Diagnosis of Rheumatic Diseases
What physical examination finding is noted in the patient?
Tenderness over the subacromial bursa without significant swelling or redness.
p.41
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is one of the diagnostic criteria for Systemic Lupus Erythematosus (SLE)?
Malar rash (butterfly rash).
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the primary symptom of gout in the presented case?
Sudden, severe pain in the right big toe.
p.21
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What physical findings may indicate osteoarthritis?
Bony hypertrophy and bony tenderness in weight-bearing areas.
p.21
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is the purpose of lab tests in the context of osteoarthritis?
To look for medication side effects.
p.25
Therapeutic Approaches in Rheumatology
What should be done with cDMARDs before surgery?
They should be continued through the surgery.
p.15
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
In which gender is rheumatoid arthritis (RA) more common?
Women, particularly during childbearing years.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What genetic factor increases susceptibility to rheumatoid arthritis (RA)?
Certain HLA-DRB1 alleles (shared epitope).
p.63
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is plaque psoriasis?
A chronic autoimmune skin condition characterized by red, scaly patches.
p.62
Therapeutic Approaches in Rheumatology
What is unique about Adalimumab?
It is a fully humanized anti-TNF alpha IgG1.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the two sets of criteria used for diagnosing Rheumatoid Arthritis (RA)?
There are two sets of diagnostic criteria for RA, but specific details are not provided.
p.26
Gout and Pseudogout Pathophysiology
What is secondary gout caused by?
Increased nucleic acid turnover due to increased amidoPRT.
p.7
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
What are Heberden’s nodes?
Osteophytes in distal interphalangeal joints.
p.62
Therapeutic Approaches in Rheumatology
What is the primary use of Anakinra?
To treat rheumatoid arthritis (RA).
p.63
Therapeutic Approaches in Rheumatology
What conditions is Tofacitinib used to treat?
Psoriatic arthritis, rheumatoid arthritis (RA), and ankylosing spondylitis.
p.26
Gout and Pseudogout Pathophysiology
What causes calcium deposition in joints?
Inflammation in joint chondrocytes.
p.63
Therapeutic Approaches in Rheumatology
What condition is Baricitinib primarily used for?
Rheumatoid arthritis (RA).
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What effect does hyperexpression of CD40 ligand have in SLE?
It leads to increased T cell activation.
p.60
Therapeutic Approaches in Rheumatology
What are the adverse effects associated with Zoledronic acid?
Nephrotoxicity and seizures, but no esophagitis.
p.27
Therapeutic Approaches in Rheumatology
How is cholecalciferol converted to calcidiol?
By the enzyme 25-hydroxylase in the liver.
p.2
Inflammatory Mediators and Cytokines
What are some key inflammatory mediators involved in the inflammatory response?
Histamine, cytokines (e.g., IL-1, IL-6, TNF-α), prostaglandins, leukotrienes, complement proteins, chemokines.
p.2
Complement System in Immune Response
How does C5a contribute to the inflammatory response?
C5a acts as a potent chemoattractant, attracting neutrophils, monocytes, and other phagocytes to the site of infection, enhancing the inflammatory response.
p.20
Pathological Features of Osteoarthritis vs. Rheumatoid Arthritis
Is there a genetic component to osteoarthritis?
Yes, there are genetic dispositions.
p.3
Innate and Adaptive Immune Systems
Which cells are the primary producers of interferon-gamma (IFN-γ)?
Natural killer (NK) cells and TH1 (T-helper 1) cells.
p.3
Therapeutic Approaches in Rheumatology
What is the function of Etanercept in rheumatoid arthritis (RA)?
It acts as a decoy receptor for tumor necrosis factor (TNF), reducing inflammation.
p.45
Therapeutic Approaches in Rheumatology
What is the goal of treatment after a renal biopsy?
To decrease proteinuria and reduce steroid dosage.
p.24
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What are the radiologic changes associated with rheumatoid arthritis?
Eroded joints with disease progression.
p.7
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What role does complement play in Systemic Lupus Erythematosus (SLE)?
Complement activation contributes to inflammation and tissue damage in SLE.
p.41
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What type of photosensitivity is a criterion for SLE?
Photosensitivity (skin rash as a result of unusual reaction to sunlight).
p.28
Vaccination Guidelines for Autoimmune Patients
What type of vaccine is composed of bacterial capsule antigens?
Capsular polysaccharides vaccines.
p.64
Therapeutic Approaches in Rheumatology
What are the risks associated with non-selective NSAIDs?
Higher risk of gastrointestinal bleeding and ulcers.
p.1
Innate and Adaptive Immune Systems
What is extravasation in the context of the immune response?
The process of moving leukocytes from blood to tissue, involving rolling, activation, adhesion, and transendothelial migration.
p.15
Clinical Presentation and Diagnosis of Rheumatic Diseases
Which extra-articular symptom is associated with Sjögren’s syndrome?
Keratoconjunctivitis sicca.
p.22
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is a common progression pattern of symptoms in rheumatoid arthritis (RA)?
Do well for 2 years, but then get worse after this.
p.61
Therapeutic Approaches in Rheumatology
What is the mechanism of action of Romosozumab?
Blocks sclerostin, increases bone formation, and decreases bone resorption.
p.28
Vaccination Guidelines for Autoimmune Patients
What are contraindications for vaccination?
Severe allergic reactions to vaccine components or immunocompromised states in certain vaccine types.
p.60
Gout and Pseudogout Pathophysiology
What should Pegloticase not be used with?
Xanthine oxidase inhibitors (XOIs) or uricosurics.
p.63
Therapeutic Approaches in Rheumatology
What is the mechanism of action of Belimumab?
It blocks BlyS and inhibits the survival of B cells.
p.35
Therapeutic Approaches in Rheumatology
Do NSAIDs prevent the progression of rheumatoid arthritis?
No, NSAIDs do NOT prevent progression of RA.
p.36
Therapeutic Approaches in Rheumatology
What treatment is recommended for Adult onset Still’s Disease?
IL-1 inhibitor (daily shot then monthly).
p.44
Therapeutic Approaches in Rheumatology
What are the steroid dosage guidelines for SLE?
Low doses for minor involvement, moderate doses for moderate involvement, and high doses for severe presentations.
p.59
Gout and Pseudogout Pathophysiology
Does Febuxostat require dosing adjustments?
No dosing adjustment is required.
p.59
Gout and Pseudogout Pathophysiology
What are the adverse effects associated with Febuxostat?
Hypersensitivity reactions, hepatotoxicity, and arthralgia.
p.59
Gout and Pseudogout Pathophysiology
What is the mechanism of action of Probenecid?
It inhibits the resorption of uric acid, increasing renal elimination.
p.18
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a common symptom of pseudogout?
Acute onset of pain and swelling in the knee.
p.1
Innate and Adaptive Immune Systems
What is the primary function of the adaptive immune system?
Provides a specific response to pathogens via lymphocytes (B and T cells) and has memory capabilities for stronger responses upon re-exposure.
p.62
Therapeutic Approaches in Rheumatology
What is the mechanism of action of Etanercept?
It acts as a decoy TNF alpha receptor.
p.36
Therapeutic Approaches in Rheumatology
What is the current approach to treatment?
Treat to target (clinical remission) and early use of cDMARDs and biologic agents.
p.28
Vaccination Guidelines for Autoimmune Patients
What are some adverse effects of vaccination?
Possible allergic reactions, mild fever, or local inflammation at the injection site.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What role do sex hormones play in RA?
Women are more likely to get RA due to the influence of sex hormones.
p.36
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are common co-morbid conditions to control?
Osteoporosis, cardiovascular disease, and vaccination status.
p.61
Therapeutic Approaches in Rheumatology
What type of drug is Denosumab?
A monoclonal antibody targeting RANKL.
p.11
Gout and Pseudogout Pathophysiology
What is often associated with gout?
Elevated serum uric acid levels.
p.59
Gout and Pseudogout Pathophysiology
What is Febuxostat indicated for?
Recurrent gout and hyperuricemia, but not for asymptomatic treatment.
p.60
Therapeutic Approaches in Rheumatology
What is the mechanism of action of Etidronate?
Inhibits ATP-dependent intracellular enzymes and promotes osteoclast apoptosis.
p.23
Clinical Presentation and Diagnosis of Rheumatic Diseases
What imaging technique is utilized in the evaluation of RA?
X-ray evaluation is used in the diagnosis of RA.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is the immunopathogenesis of systemic lupus erythematosus (SLE)?
SLE is an autoimmune disease where the immune system attacks nuclear antigens, causing widespread inflammation and organ damage.
p.35
Therapeutic Approaches in Rheumatology
What are the potential issues associated with DMARDs?
DMARDs can cause lung, liver, and bone marrow issues.
p.60
Therapeutic Approaches in Rheumatology
What conditions does Zoledronic acid treat?
Osteoporosis, Paget’s disease, osteolytic bone metastases of solid tumors, and multiple myeloma.
p.5
Activation and Role of T Cells and B Cells
What is T cell dependent B cell activation?
A process where T cells help activate B cells, leading to isotype switching and somatic hypermutation.
p.5
Complement System in Immune Response
How does opsonization and complement activation lead to inflammation?
Both processes enhance the immune response and promote inflammation.
p.16
Clinical Presentation and Diagnosis of Rheumatic Diseases
What are the routine labs included in arthritis screening?
CBC, chemistry (lytes), glucose, liver function test, CPK, uric acid, urinalysis.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What type of hypersensitivity is involved in RA?
Type III hypersensitivity, where immune complexes deposit in tissues and trigger inflammation.
p.63
Therapeutic Approaches in Rheumatology
What conditions is Upadacitinib used to treat?
Psoriatic arthritis, RA, ankylosing spondylitis, and spondylarthritis.
p.27
Gout and Pseudogout Pathophysiology
What is the difference between calcium pyrophosphate and calcium hydroxyapatite?
Calcium hydroxyapatite is small and hexagonal, found in bone and teeth, while calcium pyrophosphate is larger and rod-shaped.
p.61
Therapeutic Approaches in Rheumatology
What is the primary use of Raloxifene?
Reduces bone resorption and breast cancer risk.
p.61
Therapeutic Approaches in Rheumatology
What are the main uses of Conjugated estrogens/Bazedoxifene?
Treats osteoporosis and vasomotor symptoms.
p.27
Therapeutic Approaches in Rheumatology
What is the role of the kidney in vitamin D metabolism?
It converts calcidiol to the active form of vitamin D by 1alpha-hydroxylase, with PTH increasing activity.
p.5
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
How do CD4+ T cells contribute to the pathogenesis of RA?
They activate macrophages and B cells, perpetuating inflammation.
p.29
Vaccination Guidelines for Autoimmune Patients
When should vaccines ideally be administered in relation to immunosuppressive therapy?
Before initiating immunosuppressive therapy.
p.62
Therapeutic Approaches in Rheumatology
Which conditions can Tocilizumab treat?
Psoriatic arthritis, RA, and giant cell arteritis.
p.62
Therapeutic Approaches in Rheumatology
What conditions is Secukinumab indicated for?
Psoriasis, psoriatic arthritis, and ankylosing spondylitis.
p.61
Therapeutic Approaches in Rheumatology
What are the adverse effects of Calcitonin?
Malignancy and hypocalcemia.
p.11
Clinical Presentation and Diagnosis of Rheumatic Diseases
What does the PQRST method stand for in symptom description?
Pattern, Quality, Radiation, Severity, Timing.
p.35
Therapeutic Approaches in Rheumatology
What do TNF inhibitors target?
They target and inhibit tumor necrosis factor-alpha (TNF-α), a key inflammatory cytokine in RA.
p.5
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What is the role of B cells in rheumatoid arthritis?
They produce autoantibodies that contribute to immune complex formation and further inflammation.
p.44
Therapeutic Approaches in Rheumatology
What DMARDs are used for minor disease in SLE?
Hydroxychloroquine, methotrexate, Leflunomide, and Belimumab.
p.11
Clinical Presentation and Diagnosis of Rheumatic Diseases
What is a common symptom of bone disorders?
Localized pain and night pain.
p.27
Therapeutic Approaches in Rheumatology
What is unique about vitamin D compared to other vitamins?
It is the only vitamin that the body can make on its own.
p.27
Therapeutic Approaches in Rheumatology
What happens to 7-dehydrocholesterol in the skin?
It is stored in the skin.
p.27
Therapeutic Approaches in Rheumatology
What are some consequences of vitamin D deficiency?
Rickets (Genu Varum), poor absorption of calcium, and osteomalacia.
p.6
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What antibodies are commonly produced in SLE?
Anti-nuclear antibodies (ANAs), anti-DNA antibodies, and anti-RNA antibodies.
p.62
Therapeutic Approaches in Rheumatology
What is the mechanism of action of Abatacept?
It inhibits T cell activation by binding to CD80/86.
p.27
Therapeutic Approaches in Rheumatology
What is the first step in vitamin D synthesis?
Cholesterol in the liver is converted to 7-dehydrocholesterol by cholesterol dehydrogenase.
p.35
Therapeutic Approaches in Rheumatology
What are tsDMARDs?
Targeted synthetic DMARDs that target specific molecules within immune cells, e.g., JAK inhibitors like tofacitinib.
p.5
Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What drives the immunopathogenesis of rheumatoid arthritis (RA)?
An autoimmune reaction leading to chronic inflammation in joints, driven by autoreactive T cells and autoantibodies.
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Vaccination Guidelines for Autoimmune Patients
When should live vaccines be administered for patients on immunosuppressive therapy?
Before starting therapy or when at the lowest effective dose.
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Therapeutic Approaches in Rheumatology
What is Ixekizumab used to treat?
Psoriasis, psoriatic arthritis, and ankylosing spondylitis.
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Therapeutic Approaches in Rheumatology
What is the difference between biologics and DMARDs?
DMARDs modify disease progression, while biologics target specific immune components.
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Activation and Role of T Cells and B Cells
What are the main functions of antibodies?
Neutralization, opsonization, ADCC, and complement activation.
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Immunopathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus
What role does TNF play in rheumatoid arthritis?
It promotes inflammation, leading to joint damage.
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Vaccination Guidelines for Autoimmune Patients
What is the recommendation for COVID-19 vaccines for patients with autoimmune diseases?
Strongly recommended and safe.
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Therapeutic Approaches in Rheumatology
What DMARDs are used for major disease in SLE?
Azathioprine, MMF, and cytotoxic agents.
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Therapeutic Approaches in Rheumatology
What are examples of biologics used in rheumatoid arthritis?
IL-1 inhibitors and TNF inhibitors.
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Therapeutic Approaches in Rheumatology
What are csDMARDs?
Conventional synthetic DMARDs like methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine.
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Therapeutic Approaches in Rheumatology
What are examples of TNF inhibitors?
Etanercept, infliximab, and adalimumab.
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Vaccination Guidelines for Autoimmune Patients
What syndrome is linked to the swine flu vaccine from 1976?
Guillain-Barré Syndrome (GBS).
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Therapeutic Approaches in Rheumatology
What is a unique adverse effect of Ibandronate?
Jaw-related issues, but no esophagitis.
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Gout and Pseudogout Pathophysiology
What are the adverse effects of Probenecid?
Hemolytic anemia and increased risk in G6PD deficiency.
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Activation and Role of T Cells and B Cells
What are the two career decisions B cells can make after activation?
To become plasma cells or memory cells.
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Complement System in Immune Response
What is the role of the complement system in the immune response?
It enhances the ability of antibodies and phagocytic cells to clear pathogens through opsonization, cell lysis, and inflammation.
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Vaccination Guidelines for Autoimmune Patients
What is the current recommendation for inactivated vaccines for patients with autoimmune diseases?
Generally safe and recommended.
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Therapeutic Approaches in Rheumatology
What are the adverse effects of Raloxifene?
Deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke.
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Therapeutic Approaches in Rheumatology
What are the adverse effects of Conjugated estrogens/Bazedoxifene?
Endometrial cancer, DVT, stroke, and dementia.
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Complement System in Immune Response
What triggers the activation of the complement system?
The classical pathway (antibody binding), alternative pathway (pathogen surface), or lectin pathway (mannose-binding lectin).
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Vaccination Guidelines for Autoimmune Patients
Is the risk of Guillain-Barré Syndrome higher from the flu or the flu vaccine?
More likely to get GBS from the flu than from the flu vaccine.
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Therapeutic Approaches in Rheumatology
What antigen does Rituximab bind to?
The CD20 antigen on B lymphocytes.
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Therapeutic Approaches in Rheumatology
What is the action of Apremilast?
It is a PDE4 inhibitor that increases cAMP.
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Therapeutic Approaches in Rheumatology
What do IL-6 inhibitors target?
They target interleukin-6 (IL-6), another key component in the immune response.
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Clinical Presentation and Diagnosis of Rheumatic Diseases
What does ACA stand for in arthritis screening tests?
Anti-citrullinated protein antibodies.
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Vaccination Guidelines for Autoimmune Patients
Which vaccines should be avoided in patients on significant immunosuppression?
Live attenuated vaccines (e.g., MMR, varicella).
