Rheum_midterm_study guide_Max.docx

A red/purple rash over the shoulders, upper back, and neck, resembling a shawl draped over these areas.

Common features include fatigue, joint pain, skin rashes, and organ involvement.

A group of inflammatory muscle diseases characterized by muscle inflammation leading to muscle weakness.

The V sign rash.

Measles, Mumps, and Rubella vaccine.

Check inflammatory markers including CBC, acute-phase response, and liver function.

No, skin involvement is not necessary but often develops.

Defer other non-live attenuated vaccines except for the flu vaccine.

Advisory Committee on Immunization Practices.

Peripheral nerve involvement.

Biceps reflex.

Increased bone resorption, disorganized and accelerated bone remodeling by osteoblasts, leading to thick but fragile bone.

Rheumatoid Arthritis (RA).

B cells (produce antibodies) and T cells (CD4+ helper T cells, CD8+ cytotoxic T cells).

Large arteries.

Thickening of cortical and trabecular bone, wedge-shaped (flame sign) lesions, and bowing of the femur or tibia.

Repetitive precipitation of urate crystals, chalky deposits, and pannus that destroys underlying cartilage.

CD40/CD40 ligand binding.

Large aggregates of urate crystals.

They trigger apoptosis in self-reactive cells.

It improves slightly with activity.

Inefficient renal excretion of urate rather than overproduction.

They provide rapid relief from inflammation and symptoms during acute exacerbations.

Rash or arthritis.

CD3 is an intracellular signaling component that aids in T cell activation.

Inactivated exotoxins induce neutralizing Ig and require adjuvants to increase reactivity.

Fever, skin rashes, nodules, eye involvement, mouth ulcers, Raynaud’s phenomenon, pulmonary symptoms, cardiovascular issues, neurological symptoms, and kidney involvement.

Glucosamine does not reduce inflammation and is not useful in RA.

Proteinuria or cellular casts.

Elevated serum alkaline phosphatase (ALP).

A rare form of sarcoidosis where granulomas involve skeletal muscles, leading to inflammation and damage.

Hold methotrexate for 2 weeks after vaccination.

Enlarged hilar lymph nodes and a reticulated pattern in joints (less common).

Check blood pressure in both arms.

Nodular masses of monosodium urate crystals deposited in the soft tissues of the body.

DMARD (Disease-Modifying Anti-Rheumatic Drug).

Monosodium urate crystals.

Necrotizing.

Follicular plugging.

The lungs.

Paste lesions.

Arthritis primarily involves inflammation of the joints, while nonarticular rheumatological diseases affect other tissues and systems without joint inflammation.

Sm.

Familial chondrocalcinosis.

Live Attenuated Influenza Vaccine, quadrivalent.

A lanthanide.

Inflammatory arthritis is characterized by joint inflammation, pain, and swelling, while non-inflammatory arthritis typically involves joint pain without significant inflammation.

Molecular mimicry, where vaccine antigens resemble self-antigens.

Increased risk of cardiovascular disease.

By enhancing immune responses that may lead to self-reactivity.

Varicella (chickenpox) vaccine.

Non-inflammatory arthritis, specifically osteoarthritis.

Individuals with certain genetic backgrounds may be more susceptible to autoimmune reactions post-vaccination.

ANCA tests (proteinase vs. myeloperoxidase).

Triceps reflex.

The involvement of granulomas in skeletal muscles.

Wegener’s Granulomatosis.

MPA.

Less common.

Churg Strauss Syndrome (Eosinophilic granulomatosis with polyangiitis).

Pulseless disease, indicated by absent pulse and presence of bruits.

In the soft tissues of the body.

Purple lesions on the dorsal part of the hand.

Dermatomyositis, polymyositis, and inclusion body myositis.

Lupus spares the nasal labial fold, while dermatomyositis involves it.

LAIV4, MMR, and VAR.

Men.

Vaccination.

Yes, but it should be monitored carefully.

Facial erythema, widespread erythema, bullous lesions, and cheilitis.

4 weeks.

Necrosis.

Accumulation of calcium pyrophosphate crystals in the joints.

A non-neoplastic disorder of the bone.

4 weeks.

Germline mutation in the pyrophosphate transport channel.

A disorder of purine metabolism characterized by acute attacks of inflammatory arthritis due to urate crystal deposition.

Systemic Lupus Erythematosus (SLE).

In magnets, lasers, and nuclear reactors.

Hot osteolytic stage with large osteoclasts and increased nuclei.

Females are more affected than males.

By the presence of monosodium urate (MSU) crystals in synovial fluid for gout.

Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Psoriasis, Crohn’s disease, and Multiple Sclerosis (MS).

Yes, it is found in various minerals.

Knee jerk.

It helps in accurate diagnosis and treatment of the condition.

LAIV4, MMR, and VAR.

They need to be on birth control.

Brachioradialis reflex.

Asymptomatic, localized bone pain, cranium enlargement, platybasia, pelvic alterations, hearing loss, and high output cardiac failure.

Upper respiratory tract, lungs, and kidneys involvement.

Dull and aching pain, stiffness after rest lasting less than 30 minutes, and pain relieved by rest and acetaminophen.

Inflammation in the blood vessel walls that causes vessel narrowing, blockage, aneurysm, or rupture.

Asthma.

Stage III.

CTLA-4 upon activation.

Children.

Renal complications arising from urate crystals.

7/10.

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.

Fluid in the bursa.

NSAIDs that specifically inhibit the COX-2 enzyme, such as celecoxib and etoricoxib.

Hemolytic anemia.

Abatacept.

Conduction abnormalities.

Adverse effects include nephrotoxicity, hypertension, and increased risk of infections.

They should be withheld before surgery; if missed, wait two weeks to restart.

Calcium pyrophosphate dihydrate (CPPD) crystals.

60%.

HGPRT.

Weight loss, depression, and suicidal ideation.

Synovitis, polyarticular joints, involvement of wrist, 2nd, 3rd MCP and MTP joints (hip involvement is rare).

Hypersensitivity reactions, Steven Johnson syndrome, and toxic epidermal necrolysis.

NSAIDs.

Calcium pyrophosphate dihydrate (Ca py) crystals.

Vaccines can activate T cells that may cross-react with self-tissues.

Cortical thickening and coarse trabeculations.

Eosinophilic inflammation.

Stiffness.

Older population.

Positive ANA (Antinuclear Antibody).

Narrowing, blockage, aneurysm, or rupture of blood vessels.

Using the lowest effective dose, co-prescribing gastroprotective agents, and regular monitoring of renal function.

Monoarticular arthritis often has sudden onset, while polyarticular arthritis may have a gradual onset.

Rest and NSAIDs.

It binds to TNF alpha, preventing it from interacting with its natural receptors.

Azathioprine is a prodrug that gets converted to 6-mercaptopurine, which inhibits purine synthesis, leading to decreased lymphocyte proliferation.

Plaques on the cheek and nose.

They provide anti-inflammatory effects with potentially fewer gastrointestinal side effects.

Calcineurin inhibitors block the activation of T cells by inhibiting the phosphatase activity of calcineurin, which is necessary for T cell activation.

CBC, chemistries, urine analysis, ANA, dsDNA, ENA, Sjogren’s Abs, phospholipid Abs, and anti-C1q.

Multiple Sclerosis (MS), optic neuritis, congestive heart failure (CHF).

Osteophytes on X-ray and narrowing of joint space.

It is sensitive but not specific to SLE.

Adjusting therapies to achieve specific, measurable goals like remission or low disease activity.

HLA DR4 and HLA DR1.

Methotrexate.

Pain at rest, limitation of motion, morning stiffness, fatigue.

Steroids can be used as a bridge, but they reduce long-term life expectancy.

Anaphylactic reactions.

CCP antibodies (ACVPA or ACA) are used in the diagnosis of RA.

RF is an autoantibody that targets the Fc region of IgG, forming immune complexes that contribute to RA pathogenesis.

Elevated creatine kinase (CK) levels.

Osteoarthritis (OA).

Usually over 50 years old.

Skin rash, arthritis, and minor chest pain.

Arthritis that affects multiple joints.

Localized, sharp pain that worsens with overhead activities or lying on the affected side.

Neutrophils and macrophages.

Elevated ESR and CRP, positive rheumatoid factor (RF) and anti-CCP antibodies.

ETA protein is a marker used in assessing disease activity.

Synovial fluid analysis helps in evaluating disease activity.

By blocking the activity of COX enzymes, which reduces the synthesis of prostaglandins.

They decrease prostaglandin synthesis, leading to anti-inflammatory and analgesic effects.

They are the first to detect pathogens and can travel to present antigens.

Complement levels (e.g., C3, C4) are often low due to consumption.

Heart and renal risks; they do not prevent progression of RA.

Needle-shaped monosodium urate crystals with negative birefringence.

Tacrolimus is indicated for organ transplantation and severe autoimmune diseases.

Lymphocytes and platelets.

Tuberculosis (TB).

Fatigue, joint pain, and a butterfly-shaped facial rash.

A chimeric monoclonal antibody.

X-rays.

Men, particularly before age 60.

Gout.

Antimalarials, steroids, DMARDs, and biologics.

A post-translational modification where arginine is converted to citrulline, leading to targeting of citrullinated proteins by the immune system.

Progressive muscle weakness, particularly in the shoulders and hips.

Agonist at PTH1R, stimulating bone growth.

cDMARDs like anti-malarial and sulfasalazine do not reduce immune factors.

Without redness, swelling, or warmth.

Swelling, warmth, redness, and pain.

Flattening of the skull.

Blood is shunted from the internal carotid to the bones rather than the brain.

Ankle jerk.

C3a functions as a chemoattractant, recruiting immune cells such as eosinophils and basophils to the site of infection or inflammation.

Excessive load on a normal joint or normal load on a defective joint.

Monitoring for adverse events such as gastrointestinal bleeding, renal impairment, and cardiovascular risks.

To help prevent and treat lupus nephritis (LN).

An inflammatory process.

It restores proliferation and access to follicles.

Proliferative changes, inflammation, and signs of chronicity.

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.

By the presence of Histone Ab and Phospholipid Ab.

Hydralazine, procainamide, quinidine, chlorpromazine, HMG CoA inhibitors, and isoniazid.

Pain with use, stiffness, and range of motion issues.

A specific appearance related to certain conditions.

Hypercalciuria and hypercalcemia.

Minimal inflammation.

Presence of anti-nuclear antibodies (ANA).

AmidoPRT.

Anti-citrullinated protein antibody (ACPA).

Women are more likely to develop OA, especially in the knees and hands, and experience more severe symptoms post-menopause.

Women often experience RA at an earlier age during their childbearing years.

It binds to tubulin, inhibits phagocytosis, disrupts NLRP3 inflammasome activity, and lowers IL-1B release.

TNF-alpha inhibitor.

Eburnation refers to the narrowing of joint space from reactive bone in areas of cartilage loss.

Psoriasis.

Lesch-Nyhan syndrome.

RA has a higher prevalence in females compared to males.

In patients with urolithiasis.

HIV and hepatitis.

Antibodies bind to antigens on pathogens, marking them for destruction (opsonization), neutralizing toxins, and activating the complement system, which enhances inflammation.

55 years old.

Organ involvement, psychosis, and bleeding problems.

Individualizing therapy ensures optimal pain relief while minimizing adverse effects based on patient-specific factors.

Prominent irregular basophilic cement lines.

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.

Aneurysm formation.

If there is glomerular hematuria, cellular casts, persistent proteinuria, or unexplained decrease in GFR.

It often presents with skin manifestations and systemic symptoms.

Intervening early, within less than 5 years of onset, is crucial for better disease management.

Common adverse effects include gastrointestinal disturbances, increased risk of infections, and bone marrow suppression.

Systemic lupus erythematosus (SLE), systemic juvenile idiopathic arthritis, and vasculitis.

Uric acid.

Increased risk of cardiovascular events.

They are mRNA vaccines.

Anti-double-stranded DNA or anti-Smith antibodies.

Genetic predisposition with environmental trigger.

Adverse effects may include hypertension, nephrotoxicity, and increased risk of infections.

Uricase catalyzes the oxidation of uric acid to allantoin.

Cartilage injury leads to chondrocyte proliferation, hypertrophic chondrocyte formation, cartilage ossification, and osteophyte development.

A pegylated humanized antigen Fab fragment.

Rheumatoid factor can indicate RA but is not definitive as it shows up in many other diseases.

Systemic lupus erythematosus (SLE) and lupus nephritis.

They are last-resort drugs for various autoimmune conditions.

Soft tissue disorders, arthritis, and bone disorders.

Diabetes, hypertension, and osteoporosis.

They prevent NTP from folding, which helps prevent calcium buildup.

Plasma urate levels above 6.8 mg/dl.

Arthritis that affects a single joint.

Combination therapy with cyclophosphamide.

Rheumatoid Arthritis (RA).

Palpable purpura, arthritis, glomerulonephritis, and mesenteric ischemia.

Lung rub, fluid in abdomen, and edema in limbs.

Transition from the mosaic pattern to a more sclerotic appearance.

They help prevent and treat lupus nephritis.

Conditions like giant cell arteritis and polymyalgia rheumatica.

Counting the number of affected joints.

Macrophages, neutrophils, dendritic cells, natural killer (NK) cells, eosinophils, basophils.

Discoid rash.

Abuse and death risks.

PRRs (Pattern Recognition Receptors) bind to PAMPS (Pathogen-Associated Molecular Patterns) to detect pathogens.

Chronic inflammation.

Flare, irritation, infection, bleeding, hypopigmentation, and diabetes flare.

Seizures or psychosis.

Rhomboid-shaped calcium pyrophosphate crystals with positive birefringence.

Found incidentally on chest x-ray.

Hormonal changes after 50 can contribute to the development of OA in women.

Positive ANA and anti-dsDNA antibodies, anemia, and mild proteinuria.

DAS28, CDAI, or SDAI scores.

Progressive tightening of the skin on hands and face.

Smoking increases risk through higher levels of DNA methylation and induces peptidyl deaminase in alveolar macrophages.

Hepatic necrosis.

3 weeks.

Usually normal or not elevated.

Splenomegaly.

NTP increases the production of pyrophosphate.

Inhibits osteoclastic bone resorption.

UV light and smoking.

Dense inflammatory infiltrate and long slender needle-shaped urate crystals.

Mosaic pattern of lamellar bone.

Large vessel, medium vessel, and small vessel vasculitis.

Eye conditions.

Rheumatoid arthritis, lupus, or psoriatic arthritis.

9:1 female to male.

Glucocorticoids reduce inflammation and suppress the immune response.

The ACR (American College of Rheumatology) scoring system.

It refers to the similarity between foreign antigens and self-antigens, which can lead to autoimmune responses, as seen in GBS and Schwann cells.

Ibuprofen, naproxen, and diclofenac.

Skin nodules, vasculitis, dry eyes, lung disease, cardiovascular disease, anemia, neuropathy, kidney issues.

Eye involvement can occur.

IL-1, IL-6, and TNF-alpha.

Malar rash.

Making purines from scratch, with glutamine as a precursor for adenine and guanine biosynthesis.

To tailor treatment based on benefits and risks for rheumatological diseases.

Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase, leading to decreased lymphocyte proliferation.

It increases purine turnover, resulting in higher uric acid concentration.

Collagenases MMP-1,3,9,14 play the most important role in OA.

Myocardial infarction (MI), stroke, and cardiovascular death.

They exhibit positive birefringence.

It is used for recurrent gout and hyperuricemia.

Blood tests for inflammatory markers, autoantibodies, and imaging studies like X-rays or MRIs.

Female to male ratio is 3:1.

Mg is needed for the reaction via the enzyme NTP.

High levels of xanthine in urinary excretion, leading to xanthinuria.

Osteoporosis and Paget’s disease.

Osteonecrosis of the jaw and esophagitis.

It refers to the process where an immune response to a vaccine leads to the recognition of additional self-antigens.

Mixed osteolytic-osteoblastic phase with osteoclasts eroding bone and deposits of osteoid.

NSAIDs are used for pain management and to reduce inflammation in conditions like rheumatoid arthritis and osteoarthritis.

The process by which self-reactive B cells and T cells are eliminated to prevent autoimmunity.

More than an hour.

For the past two weeks (acute).

They secrete IFN-γ, activating macrophages to kill intracellular bacteria.

Provides the first line of defense with nonspecific responses, including barriers and phagocytic cells.

Skin and mucous membranes.

Increased risk due to autoimmune disease and medications like glucocorticoids, DMARDs, and biologics.

Cyclophosphamide is used for severe autoimmune diseases such as systemic lupus erythematosus and vasculitis.

Social support, education, assistive devices, weight reduction, thermal modalities, muscle strengthening.

Rituximab.

Select antigens that attach to host cells or virulence, inducing neutralizing and/or opsonizing Ig.

Microbes are cultured to lose the ability to cause disease but can still grow in the host.

Noncaseating epithelioid granuloma.

Females are more affected than males.

To provide immunity against specific diseases, especially in at-risk populations.

Steroids (moderate dose).

Cellular infiltration of synovium (no osteophytes).

CBC, CMP, UA, UPCR, C3 and C4 levels, dsDNA levels, and disease activity indexes.

Persistent pain despite treatment and physical therapy, loss of joint function, or fracture.

Raynaud's phenomenon.

Risk of infections, jaw issues, hypocalcemia, and hypophosphatemia.

Tumor lysis syndrome.

ESR (Erythrocyte Sedimentation Rate) and C-RP (C-Reactive Protein) are used.

Hypercalcemia and osteosarcoma.

Avoid hydroxychloroquine with retinal disease and low G6PD.

Needle-shaped and exhibit negative birefringence under polarized light microscopy.

Joint space narrowing and osteophyte formation.

Increased cardiac input leads to cardiac failure.

Injury or infection in one joint.

Dropped pelvis on the normal side and trunk bending towards the involved side.

Transmural inflammation.

It permits expansion of B and T cells, potentially leading to autoimmunity.

It can cause ischemia and organ damage due to blockage.

Tenderness over the subacromial bursa without significant swelling or redness.

Malar rash (butterfly rash).

Sudden, severe pain in the right big toe.

Bony hypertrophy and bony tenderness in weight-bearing areas.

To look for medication side effects.

They should be continued through the surgery.

HLA-DR4.

Women, particularly during childbearing years.

Certain HLA-DRB1 alleles (shared epitope).

A chronic autoimmune skin condition characterized by red, scaly patches.

It is a fully humanized anti-TNF alpha IgG1.

There are two sets of diagnostic criteria for RA, but specific details are not provided.

About 9:1.

Increased nucleic acid turnover due to increased amidoPRT.

Osteophytes in distal interphalangeal joints.

To treat rheumatoid arthritis (RA).

Psoriatic arthritis, rheumatoid arthritis (RA), and ankylosing spondylitis.

Inflammation in joint chondrocytes.

Rheumatoid arthritis (RA).

It leads to increased T cell activation.

Nephrotoxicity and seizures, but no esophagitis.

By the enzyme 25-hydroxylase in the liver.

Histamine, cytokines (e.g., IL-1, IL-6, TNF-α), prostaglandins, leukotrienes, complement proteins, chemokines.

Antigen presentation.

Hip abductor weakness.

C5a acts as a potent chemoattractant, attracting neutrophils, monocytes, and other phagocytes to the site of infection, enhancing the inflammatory response.

Yes, there are genetic dispositions.

Natural killer (NK) cells and TH1 (T-helper 1) cells.

6 out of 10.

It acts as a decoy receptor for tumor necrosis factor (TNF), reducing inflammation.

To decrease proteinuria and reduce steroid dosage.

Eroded joints with disease progression.

Complement activation contributes to inflammation and tissue damage in SLE.

Photosensitivity (skin rash as a result of unusual reaction to sunlight).

Capsular polysaccharides vaccines.

Higher risk of gastrointestinal bleeding and ulcers.

The process of moving leukocytes from blood to tissue, involving rolling, activation, adhesion, and transendothelial migration.

Keratoconjunctivitis sicca.

Do well for 2 years, but then get worse after this.

More common in females.

Blocks sclerostin, increases bone formation, and decreases bone resorption.

Rhomboid-shaped.

Severe allergic reactions to vaccine components or immunocompromised states in certain vaccine types.

Xanthine oxidase inhibitors (XOIs) or uricosurics.

It blocks BlyS and inhibits the survival of B cells.

No, NSAIDs do NOT prevent progression of RA.

IL-1 inhibitor (daily shot then monthly).

Low doses for minor involvement, moderate doses for moderate involvement, and high doses for severe presentations.

No dosing adjustment is required.

Hypersensitivity reactions, hepatotoxicity, and arthralgia.

It inhibits the resorption of uric acid, increasing renal elimination.

In the skin.

Acute onset of pain and swelling in the knee.

Provides a specific response to pathogens via lymphocytes (B and T cells) and has memory capabilities for stronger responses upon re-exposure.

It acts as a decoy TNF alpha receptor.

Treat to target (clinical remission) and early use of cDMARDs and biologic agents.

Possible allergic reactions, mild fever, or local inflammation at the injection site.

Women are more likely to get RA due to the influence of sex hormones.

Osteoporosis, cardiovascular disease, and vaccination status.

A monoclonal antibody targeting RANKL.

Elevated serum uric acid levels.

To guide therapy.

Recurrent gout and hyperuricemia, but not for asymptomatic treatment.

Inhibits ATP-dependent intracellular enzymes and promotes osteoclast apoptosis.

X-ray evaluation is used in the diagnosis of RA.

SLE is an autoimmune disease where the immune system attacks nuclear antigens, causing widespread inflammation and organ damage.

DMARDs can cause lung, liver, and bone marrow issues.

Osteoporosis, Paget’s disease, osteolytic bone metastases of solid tumors, and multiple myeloma.

A process where T cells help activate B cells, leading to isotype switching and somatic hypermutation.

Both processes enhance the immune response and promote inflammation.

CBC, chemistry (lytes), glucose, liver function test, CPK, uric acid, urinalysis.

Type III hypersensitivity, where immune complexes deposit in tissues and trigger inflammation.

Psoriatic arthritis, RA, ankylosing spondylitis, and spondylarthritis.

Calcium hydroxyapatite is small and hexagonal, found in bone and teeth, while calcium pyrophosphate is larger and rod-shaped.

Reduces bone resorption and breast cancer risk.

Treats osteoporosis and vasomotor symptoms.

It converts calcidiol to the active form of vitamin D by 1alpha-hydroxylase, with PTH increasing activity.

They activate macrophages and B cells, perpetuating inflammation.

Before initiating immunosuppressive therapy.

Psoriatic arthritis, RA, and giant cell arteritis.

Psoriasis, psoriatic arthritis, and ankylosing spondylitis.

Malignancy and hypocalcemia.

Pattern, Quality, Radiation, Severity, Timing.

Embryo-fetal toxicity.

They target and inhibit tumor necrosis factor-alpha (TNF-α), a key inflammatory cytokine in RA.

They produce autoantibodies that contribute to immune complex formation and further inflammation.

The disease.

Hydroxychloroquine, methotrexate, Leflunomide, and Belimumab.

Localized pain and night pain.

It is the only vitamin that the body can make on its own.

It is stored in the skin.

Rickets (Genu Varum), poor absorption of calcium, and osteomalacia.

Adenovirus.

ESR and C-RP.

Anti-nuclear antibodies (ANAs), anti-DNA antibodies, and anti-RNA antibodies.

It inhibits T cell activation by binding to CD80/86.

Cholesterol in the liver is converted to 7-dehydrocholesterol by cholesterol dehydrogenase.

Targeted synthetic DMARDs that target specific molecules within immune cells, e.g., JAK inhibitors like tofacitinib.

An autoimmune reaction leading to chronic inflammation in joints, driven by autoreactive T cells and autoantibodies.

Before starting therapy or when at the lowest effective dose.

Psoriasis, psoriatic arthritis, and ankylosing spondylitis.

Methotrexate.

DMARDs modify disease progression, while biologics target specific immune components.

Neutralization, opsonization, ADCC, and complement activation.

It promotes inflammation, leading to joint damage.

Strongly recommended and safe.

Azathioprine, MMF, and cytotoxic agents.

IL-1 inhibitors and TNF inhibitors.

Conventional synthetic DMARDs like methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine.

Etanercept, infliximab, and adalimumab.

Guillain-Barré Syndrome (GBS).

Jaw-related issues, but no esophagitis.

Hemolytic anemia and increased risk in G6PD deficiency.

To become plasma cells or memory cells.

It enhances the ability of antibodies and phagocytic cells to clear pathogens through opsonization, cell lysis, and inflammation.

Generally safe and recommended.

Antinuclear antibodies.

Deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke.

Endometrial cancer, DVT, stroke, and dementia.

The classical pathway (antibody binding), alternative pathway (pathogen surface), or lectin pathway (mannose-binding lectin).

More likely to get GBS from the flu than from the flu vaccine.

Rheumatoid factor.

The CD20 antigen on B lymphocytes.

It is a PDE4 inhibitor that increases cAMP.

They target interleukin-6 (IL-6), another key component in the immune response.

Thrombocytopenia.

Anti-citrullinated protein antibodies.

Live attenuated vaccines (e.g., MMR, varicella).

Sjogren’s Abs.