PBL

Question 1

What is citrullination?

Answer 1

When amino acid arginine is replaced by citrulline. This can disturb the stability of proteins and cause DNA damage.

Question 2

What are the common side effects of methotrexate?

Answer 2

• loss of appetite, feeling/being sick, stomach ache or indigestion
• diarrhoea
• headaches
• feeling tired or drowsy
• hair loss

Question 3

What are the serious side effects of methotrexate?

Answer 3

• jaundice (could indicate liver problems)
• cough, chest pain, difficuly breathing, breathlessness (could indicate inflammation in lungs)
• swollen hands/ankles/feet, changes to urination or no urination (could indicate kidney problems)
• high temp, chills, muscle aches, sore throat (could indicate an infection)
• bleeding gums, blood in urine, vomitting blood, unexplained bruising (could indicate blood disorder)
• severe skin rash/blisters on skin, mouth, eyes or genitals (could indicate Stevens-Johnson syndrome)

Question 4

What is Stevens-Johnson syndrome?

Answer 4

• affects the skin, mucous membrane, genitals and eyes
• blistering and ulceration
• can lead to dehydration

Question 5

What csDMARDs may be used to treat rheumatoid arthritis?

Answer 5

• methotrexate
• leflunomide
• hydrxychloroquine
• sulfasalazine
• Gold (myocrisin)
• cyclosporin
• azathioprine
• penicillamine

Question 6

What is rheumatoid factor?

Answer 6

• autoantibodies that target antigenic determinants on the Fc fragment of IgG
• RA patients who are RF-postive tend to have more aggressive joint disease

Question 7

What are autoantibodies?

Answer 7

Antibodies that recognise ‘self’

Question 8

What is anti-cyclic citrullinated peptide (anti-CCP)?

Answer 8

• an autoantibody that attacks healthy tissue

- recognises proteins where arginine has been modified to citrulline

Question 9

How is citrullinatin associated with RA?

Answer 9

Citrullinated proteins, and the enzymes that produe them, are found in inflamed synovium.