Management of Rheumatoid Arthritis

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Management of Rheumatoid Arthritis

Question 1:

In assessment of RA, which two hallmark auto-antibody markers are used?

A) Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA)

B) Rheumatoid factor (RF) and antihistone antibodies

C) Anti-citrullinated protein antibodies (ACPA) and intrinsic factor antibodies

D) Acetylcholine receptor (AChR) antibodies and rheumatoid factor (RF)

2 / 20

Management of Rheumatoid Arthritis

Question 2:

Joint swelling characteristic of RA is a consequence of all of the following physiological changes except:

A) Inflammation in the synovial membrane

B) Hyperplasia of inflamed tissue

C) Expansion of interstitial fluid volume and inflammation in surrounding muscles

D) Formation of new bone

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Management of Rheumatoid Arthritis

Question 3:

A variation in which gene set is known to be valuable in assessing one’s predisposition to developing RA?

A) Those encoding for CYP4A

B) HLA

C) CD14

D) Hemoglobin (HBB)

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Management of Rheumatoid Arthritis

Question 4:

Classification of RA is dependent upon all but which of the following factors?

A) Number of affected joints (≥1 small joint)

B) RF and/or ACPA positivity

C) Abnormal ESR and/or CRP

D) None of the above

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Management of Rheumatoid Arthritis

Question 5:

To promote mobility and reduce stiffness, protect and stabilize joints, and improve the heart’s blood flow, exercise recommendations for RA patients should focus on which three components?

A) Strengthening exercises, anaerobic exercise, and balance

B) An equal amount of anaerobic and aerobic activity, coupled with stretching

C) Stretching, strengthening exercises, and cardiovascular activity

D) Flexibility, balance, and strengthening exercises

6 / 20

Management of Rheumatoid Arthritis

Question 6:

All but which of the following foods is believed to have anti-inflammatory properties?

A) Nightshade vegetables

B) Fatty fish

C) Almonds and walnuts

D) Plant oils

7 / 20

Management of Rheumatoid Arthritis

Question 7:

Though NSAIDs may be less toxic bridging agents compared to steroids during DMARD initiation, which of the following is an important consideration with higher doses often required during RA flares?

A) Delayed wound healing

B) CVD risk

C) Increased blood pressure

D) Angioedema

8 / 20

Management of Rheumatoid Arthritis

Question 8:

Which of the following is not a recommended course of therapy in cases of moderate or high RA disease activity?

A) TNF inhibitor biologic

B) non-TNF biologic with or without methotrexate

C) Methotrexate monotherapy

D) Combination DMARD therapy

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Management of Rheumatoid Arthritis

Question 9:

In terms of disease-drug interactions, which of the following is not an important consideration in beginning biologic DMARD therapy?

A) Screening for tuberculosis, as complete TB therapy should be completed prior to starting biologic DMARDs in active infection

B) Screening for hepatitis due to the immunosuppressive effects of biologic DMARD and risk of reactivation

C) Screening for skin cancer, as nonbiologic DMARDs should be recommended in patients with a history of skin cancer

D) Screening for diabetes, as most DMARDs are known to increase blood sugar

10 / 20

Management of Rheumatoid Arthritis

Question 10:

Methotrexate carries which of the following boxed warnings?

A) Hepatotoxicity

B) Myelosuppression

C) Mucositis/stomatitis

D) All of the above

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Management of Rheumatoid Arthritis

Question 11:

An important counseling point for patients initiating methotrexate therapy, symptoms of liver damage include all but which of the following?

A) Yellow skin or eyes

B) Unusual tiredness or weakness

C) Stomach upset or pain

D) Decreased urine production

12 / 20

Management of Rheumatoid Arthritis

Question 12:

In DMARD therapy, triply therapy involves the combined use of which 3 agents?

A) MTX + hydroxychloroquine + sulfasalazine

B) Hydroxychloroquine + sulfasalazine + either methotrexate or leflunomide

C) MTX + biologic DMARD + hydroxychloroquine

D) MTX + biologic DMARD + sulfasalazine

13 / 20

Management of Rheumatoid Arthritis

Question 13:

Which of the following is a mechanism of action by which biologic DMARDs exert their effects?

A) Depletion of T cells

B) Inhibition of B cell co-stimulation

C) Neutralization of interleukins or their receptors

D) Stimulation of either TNF-ɑ or the TNF receptor

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Management of Rheumatoid Arthritis

Question 14:

Biologic DMARDs should not be used with trimethoprim, as additive antifolate effects can result in complications such as pancytopenia. True or false?

A) True

B) False

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Management of Rheumatoid Arthritis

Question 15:

In DMARD therapy, inadequate response is defined as moderate to high disease activity despite treatment (monotherapy or combination therapy) after what length of time at target dose?

A) 3 months

B) 6 months

C) 1 months

D) 12 weeks

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Management of Rheumatoid Arthritis

Question 16:

In terms of disease improvement, if low-level disease activity is achieved, a patient’s regimen should be continued at the current dose. True or False?

A) True

B) False

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Management of Rheumatoid Arthritis

Question 17:

Which of the following is the preferred tapering regimen in disease improvement or remission?

A) Gradual discontinuation, characterized by lowering the dose of a DMARD and subsequently stopping it

B) Dose reduction, characterized by lowering the dose or increasing the dosing interval of a DMARD

C) Abrupt discontinuation

D) No reduction or discontinuation is recommended in disease improvement

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Management of Rheumatoid Arthritis

Question 18:

Which of the following is not a current approach to overcoming treatment failure in RA patients?

A) Investigation into reasons for loss of efficacy

B) Trial and error of traditional DMARD agents prior to use of novel biologic DMARDs

C) Identification of biomarkers for DMARD response or nonresponse

D) Approval of new DMARD targets

19 / 20

Management of Rheumatoid Arthritis

Question 19:

Precision medicine, classification into subpopulations that may be more responsive to a specific treatment, allows for individualized regimens but exhibits all but which of the following limitations?

A) High cost of sequencing

B) Ethical issues

C) Adherence to a standardized approach in data interpretation for healthcare providers

D) Difficulty in collection and storage of large amounts of data

20 / 20

Management of Rheumatoid Arthritis

Question 20:

Treatment failure is defined as nonresponse or limited efficacy to a specific DMARD regimen and includes all but which of the following?

A) Delayed response, sometimes as long as 6 months from initiation

B) Initial lack of response

C) Lack of responsiveness over time

D) Inadequate or partial response

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