MKSAP 16
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action of BAFF
mediates the maturation and survival of
immature B cells to antibody-secreting
plasmablasts, and its levels are elevated
in patients with SLE and Sjgren
syndrome
acute vs chronic
inflamm or
noninflamm
oligoarthritis
Acute inflammatory oligoarthritis by
gonorrhea or rheumatic fever. Chronic
inflammatory oligoarthritis by
spondyloarthritis or a connective tissue
disease. Chronic noninflammatory
oligoarthritis is usually caused by
osteoarthritis.
advantage of
febuxostat over
allopurinol
approved for patients with mild to
moderate kidney failure
adverse effects of
abatacept
increased risk of lymphoma and lung
cancer as well as flares of COPD
adverse effects of
allopurinol
rash, bone marrow failure, hepatic
failure, and Stevens-Johnson syndrome
adverse effects of
uricase and
rasburicase
highly immunogenic and is not an
option for chronic use.
adverse events
related to
cyclophosphamide
leukopenia, anemia, increased rate of
bacterial and fungal infections,
hemorrhagic cystitis and bladder
cancer, lymphoma, and other (longterm) malignancies
agents often used
in treatment of RA
in pregnant
Hydroxychloroquine and sulfasalazine
ANCA-associated
vasculitides
granulomatosis with polyangiitis (also
known as Wegener granulomatosis),
microscopic polyangiitis, and ChurgStrauss syndrome
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arthrocentesis
counts suggestive
of septic arthritis
greater than 50,000/L
corticosteroidsparing or
maintenance agent
in lupus,
vasculitis, and
polymyositis
azothioprine
cyclophosphamide
and pregnancy
never used unless life of mother is at
stake
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different
manifestations of
GCdepending on
blood vessel
involved
Cranial vessel involvement includes
jaw claudication (due to ischemia of
the masseter or temporalis muscles),
scalp tenderness, and temporal or
occipital headache. Inflammation of
the ophthalmic artery may cause
ischemia of the optic nerve, resulting
in visual loss. Involvement of the
subclavian vessels may result in upper
extremity limb claudication or
subclavian steal syndrome. Aortic
valve regurgitation may occur with
GCA involvement of the proximal
ascending aorta.
effect of
sulfasalazine in
male fertility
cause reversible oligospermia
effective as initial
monotherapy for
patients with
rheumatoid
arthritis of any
duration or degree
of activity
methotrexate or leflunomide
enzyme tht
metabolizes
azathioprine
thiopurine methyltransferase (TPMT)
extra-articular
sequelae of RA
Felty syndrom; rheumatoid vasculitis;
rheumatoid nodules; scleritis with
scleral ulceration; and interstitial lung
disease
Felty syndrome
pancytopenia, splenomegaly, and leg
ulcers
glomerulonephritis
associated with
small vessel
vasculitis
"pauci-immune" (lacking immune
complexes) glomerulonephritis
how does
methotrexate work
in rheuma
conditions?
mechanism of its benefit in rheumatic
diseases may relate not to folic acid
antagonism but to its ability to raise
extracellular adenosine levels
how is diagnosis of
Wegener,ls
granulomatosis
established?
lung or kidney biopsy
how is Takayasu
diagnosis
established?
demonstration of characteristic
narrowing of the aorta or its major
branch vessels
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human genomederived monoclonal
reagent with
specificity for the
p40 subunit shared
by IL-12 and IL-23
ustekinumab
hydroxychloroquine
pand pregnancy
pregnancy risk category C
medication, expert consensus states
that it is relatively safe in pregnancy
and should not be discontinued
indications for
colchicine
gout, pseudogout, and familial
Mediterranean fever
initial
monotherwpy for
RA with moderate
or high disease
activity
TNF- inhibitors (etanercept,
infliximab, adalimumab, golimumab,
and certolizumab pegol)
initial presentation
of Kawasaki
fever with nonexudative
conjunctivitis, pleomorphic
erythematous rash, and oral
mucositis
laboratory
abnormalities are
useful in
demonstrating the
presence of an
inflammatory
process
elevated C-reactive protein (CRP)
level, anemia of chronic disease,
thrombocytosis, and
hypoalbuminemia
large vessel
vasculitis
Giant cell, Takayasu and polymyalgia
rheumatica
leflunomide and
pregnancy
extremelynlong half life, needs
cholestyramine regimen (three times
daily for 8 days) to remove
MOA
hydroxychloroquine
in rheumatologic
disease
inhibition of antigen processing and
costimulatory activation
MOA leflunomide
blocks pyrimidine biosynthesis and
targets lymphocytes, which lack
pyrimidine salvage pathways
MOA mycophenolate
mofetil
inhibits inosine monophosphate
dehydrogenase (an enzyme in the
purine synthetic pathway).
Mycophenolic acid preferentially
inhibits T and B lymphocytes; likely
as effective as cyclophosphamide
38.
MOA of probenecid
inhibits the renal tubule transporter
URAT1 to block retention of urate
39.
MOA rituximab
chimeric monoclonal antibody that
depletes CD20+ B-cell lymphocytes,
lasts 6-12 months
40.
MOA Tocilizumab
chimeric (mouse-human)
monoclonal antibody with specificity
for the IL-6 receptor; attenuates B
and T lymphocyte activation,
leukocyte migration, osteoclast
activation, and hepatic synthesis of
acute phase reactants
monoclonal antibody
with specificity for
B-cell-activating
factor (BAFF), also
referred to as Blymphocyte
stimulator (BLyS)
belimumab
the most common
ocular condition in
rheumatoid arthritis
keratoconjunctivitis sicca
most important
toxicity from
hydroxychloroquine
visual loss resulting from retinal
pigment deposition
NOTE that selective
COX-2 inhibitors are
not safer for the
kidney
than nonselective COX inhibitors
and may exacerbate kidney disease
and hypertension
NSAID that reduces
cardiovascular risk
than nonselective COX inhibitors
and may exacerbate kidney disease
and hypertension
pegylated
recombinant
mammalian uricase
that has received
FDA approval for
treatment-failure
gout
pegloticase
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maintains the
gastric lining and
kidney blood flow
prostaglandin E2
medium size
vasulitis
PAN, Kawasaki
methotrexate
toxicities
macrocytic anemia and drug-induced
hepatitis (contraindicated in regular
ETOH consumption), highly
teratogenic
44.
MOA abatacept
fusion protein of CTLA4, a molecule
expressed on activated human T cells
and the Fc portion of human IgG.
This agent binds to antigenpresenting cells and blocks
costimulatory signals to T
lymphocytes
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primary
presenting features
of
cryoglobulinemic
vasculitis
Cutaneous purpura, mononeuritis
multiplex, and an immune complex
glomerulonephritis
side effects of
febuxostats
liver function abnormalities, which are
often transient
side effects of
leflunomide
hematopoietic abnormalities,
infection, and interstitial lung disease,
highly teratogenic
side effects of
probenecid
increase the risk of kidney stones
side effects of
rituxkmab
severe infusion reactions can occur,
and rare cases of progressive
multifocal leukoencephalopathy
associated with JC virus reactivation
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side effects of
tocilizumab
leukopenia, thrombocytopenia, and
elevated serum aminotransferase
levels. Increases in serum lipid levels
systemic vasculitis
in the spectrum of
hypereosinophilic
disorders that
most often occurs
in the setting of
antecedent asthma,
allergic rhinitis, or
sinusitis
Churg-Strauss syndrome
treatment
forpatients with
patients with
hepatitis Bassociated
polyarteritis
nodosa
corticosteroids should be given
concomitantly with antiviral therapy
(such as entecavir)
treatment of GA
1 mg/kg/d of prednisone; tapering of
prednisone is initiated after 4 to 6
weeks, typically performed in 10%
decrements every 2 weeks
treatment of
hepatitis Cassociated
cryoglobulinemia
antiviral therapy with interferon alfa
and ribavirin. A short course of
corticosteroids may be required to
suppress the acute phase of
inflammation and vasculitis; patients
with severe manifestations, including
kidney failure, digital gangrene, and
severe neurologic disease, a 2- to 3week course of plasma exchange
treatment of
Kawasaki disease?
High-dose salicylates and early
administration of intravenous immune
globulin, steroids if unresponsive
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type 1
cryoglobulins
immunoglobulins that self-aggregate and are
associated with Waldenstrom
macroglobulinemia and multiple myeloma;
they may also be seen in patients with Sjgren
syndrome or B-cell lymphoma who develop
monoclonal paraproteins
type 2
cryoglobulins
rheumatoid factors that are monoclonal IgM
or IgA immunoglobulins with specificity for
the Fc portion of IgG; this subtype is most
often associated with vasculitis and most
commonly occurs in the setting of viral
infections with hepatitis C or HIV
usual setting
of PAN
50% of cases occur in the setting of recently
acquired hepatitis B virus infection
when is urate
lowering
therapy
indicated?
repeated gout attacks (typically two or more
per year) or develop tissue deposits of urate
(tophi
when to use
abatacept
moderate or high disease activity and poor
prognostic features who have had an
inadequate response to sequential
nonbiologic DMARDs or methotrexate in
combination with other DMARD
