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Overview of Rheumatoid Arthritis
What does ACR stand for?
American College of Rheumatology.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What are DMARDs?
Disease-modifying antirheumatic drugs.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What is the role of folic acid in the treatment of lymphoproliferative disease?
Folic acid is useful for reducing adverse reactions.
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Overview of Rheumatoid Arthritis
What does EULAR stand for?
European League Against Rheumatism.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What are the recommended alternatives when methotrexate use is contraindicated?
Sulfasalazine and leflunomide.
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Overview of Rheumatoid Arthritis
What is rheumatoid arthritis primarily characterized by?
Synovitis and extra-articular organ involvement.
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Pathophysiology and Genetic Factors
What is the role of MMP in rheumatoid arthritis?
Matrix metalloproteinase, involved in tissue remodeling.
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Clinical Symptoms and Diagnosis
What are common clinical symptoms of rheumatoid arthritis?
Pain, swelling, stiffness of multiple joints, fever, and malaise.
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Clinical Symptoms and Diagnosis
What is the first step in diagnosing rheumatoid arthritis?
Excluding various diseases such as connective tissue disease, osteoarthritis, spondyloarthritis, and crystal-induced arthritis.
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Assessment of Disease Activity
What does SDAI stand for?
Simplified Disease Activity Index.
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Pathophysiology and Genetic Factors
What is the consequence of joint destruction in rheumatoid arthritis?
Irreversible physical dysfunction and deformation of affected joints.
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Clinical Symptoms and Diagnosis
What score indicates definite rheumatoid arthritis?
A score of 6 points or higher out of 10 points.
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Biologic and Targeted Synthetic DMARDs
When are biological DMARDs selected for treatment?
When responses to synthetic DMARDs are inadequate.
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Clinical Symptoms and Diagnosis
What are common respiratory symptoms associated with interstitial pneumonia in rheumatoid arthritis?
Breath on exertion or a dry cough.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What types of drugs are used to treat rheumatoid arthritis?
Disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic, targeted synthetic, and biologic DMARDs.
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Assessment of Disease Activity
What is the purpose of the 28-joint Disease Activity Score (DAS28)?
To objectively assess disease activity based on tender or swollen joints, erythrocyte sedimentation rate, and patient assessment.
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Biologic and Targeted Synthetic DMARDs
What types of drugs are used in Japan for rheumatoid arthritis treatment?
TNF-targeting drugs, IL-6-targeting drugs, and T cell-selective co-stimulation modulators.
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Clinical Symptoms and Diagnosis
What clinical findings are typically observed during examinations of rheumatoid arthritis?
Tenderness and swelling of articular soft tissues, accumulation of synovial fluid, and inflammatory findings such as swelling, redness, and hot flashes.
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Treatment Strategies and Guidelines
What is the therapeutic goal for patients with rheumatoid arthritis?
Achieving and maintaining remission.
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Biologic and Targeted Synthetic DMARDs
What is the effect of combining biological DMARDs with methotrexate?
It allows the induction of remission in approximately half of the cases.
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Clinical Symptoms and Diagnosis
How are affected joints characterized in rheumatoid arthritis?
They are usually bilateral, symmetrical, and often mobile, with patterns of joint deformation such as buttonhole and swan-neck deformities.
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Overview of Rheumatoid Arthritis
What historical treatment was first reported for rheumatoid arthritis in 1949?
The administration of cortisone.
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Treatment Strategies and Guidelines
What is the primary goal of rheumatoid arthritis treatment?
Immediate intervention after diagnosis to suppress arthritis and induce remission.
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Biologic and Targeted Synthetic DMARDs
What are JAK inhibitors classified as?
Targeted synthetic DMARDs.
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Biologic and Targeted Synthetic DMARDs
What are some examples of JAK inhibitors used for rheumatoid arthritis?
Tofacitinib, baricitinib, peficitinib, upadacitinib, and filgotinib.
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Clinical Symptoms and Diagnosis
What is the significance of elevated MMP-3 levels in rheumatoid arthritis?
MMP-3 is associated with the progression of joint destruction.
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Pathophysiology and Genetic Factors
Which gene has been identified as the most relevant disease-susceptible gene in rheumatoid arthritis?
Human leukocyte antigen D-related B1 gene (HLA-DRB1).
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Treatment Strategies and Guidelines
What vaccination is recommended for patients at risk for pneumonia?
Pneumococcal vaccination.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What is the role of TNF-targeting drugs like Infliximab?
Initially indicated for rheumatoid arthritis, now expanded to treat over 10 immune diseases.
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Long-term Management and Drug Holidays
What did the RRR and HONOR studies report about biological DMARDs?
They reported the possibility of withdrawal of biological DMARDs after remission induction in rheumatoid arthritis patients.
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Clinical Symptoms and Diagnosis
What symptoms may occur due to atlantoaxial subluxation in rheumatoid arthritis?
Occipital headache and numbness of the hands.
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Clinical Symptoms and Diagnosis
What laboratory findings are common in rheumatoid arthritis patients?
Approximately 80% test positive for rheumatoid factors, and anti-CCP antibodies have a sensitivity and specificity of 90% or higher.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What are the two classifications of DMARDs?
Synthetic DMARDs (like methotrexate) and biologic DMARDs (produced from biological agents).
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Long-term Management and Drug Holidays
What is the significance of achieving drug-free remission in rheumatoid arthritis?
It suggests that if remission can be maintained after withdrawal of biological DMARDs, a drug-free remission can be achieved.
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Treatment Strategies and Guidelines
What prophylactic measures are recommended for patients at risk for tuberculosis?
Administration of isoniazid.
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Assessment of Disease Activity
What significant findings were detected through CT scans in the monitored patients?
Early lung cancer in 11 patients and non-tuberculous mycobacteriosis in 13 patients.
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Clinical Symptoms and Diagnosis
What systemic symptoms are often observed in rheumatoid arthritis patients?
Malaise, fatigue, and fever.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What was the first monoclonal antibody therapy approved in 1998 targeting?
Tumor necrosis factor (TNF), a cytokine involved in rheumatoid arthritis pathogenesis.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What are disease-modifying antirheumatic drugs (DMARDs)?
Immunosuppressive drugs used for the treatment of rheumatoid arthritis.
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Assessment of Disease Activity
What factors are associated with the possibility of remission after withdrawal of DMARDs?
Negativity for anti-CCP antibodies, deep remission, and absence of ultrasound findings of synovitis.
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Assessment of Disease Activity
What are the risk factors for pneumonia when using biological DMARDs?
Advanced age, a history of respiratory diseases, and concomitant use of glucocorticoids.
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Extra-Articular Manifestations
What complications can arise from rheumatoid arthritis?
Extra-articular involvement affecting organs such as the eyes, lungs, heart, and skin.
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Clinical Symptoms and Diagnosis
What are the characteristic symptoms of rheumatoid arthritis?
Morning stiffness, polyarticular pain, and swelling.
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Biologic and Targeted Synthetic DMARDs
What is the role of molecular-targeted drugs in rheumatoid arthritis treatment?
They allow for targeted therapies based on pathological mechanisms and management of autoimmune inflammatory diseases.
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Long-term Management and Drug Holidays
What was the consensus reached at the 2016 International Round-table Conference regarding drug withdrawal in rheumatoid arthritis?
Drugs should be withdrawn in the order: glucocorticoids, anti-inflammatory drugs, biological DMARDs, and finally synthetic DMARDs.
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Long-term Management and Drug Holidays
What are the four requirements for the withdrawal of DMARDs?
Fulfillment of standard remission criteria, maintenance of remission for at least 6 months, maintenance of treatment with the same drugs at the same doses for at least 6 months, and no use of glucocorticoids.
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Treatment Strategies and Guidelines
What was the impact of glucocorticoids and non-steroidal anti-inflammatory drugs in the treatment of rheumatoid arthritis?
They alleviated pain and swelling but did not prevent joint destruction.
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Biologic and Targeted Synthetic DMARDs
What is necessary to establish regarding JAK inhibitors?
Evidence on their long-term safety concerning infections and malignant tumors.
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Clinical Symptoms and Diagnosis
What criteria are widely used for the diagnosis of rheumatoid arthritis?
The rheumatoid arthritis classification criteria published by the ACR and EULAR in 2010.
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Future Directions in Rheumatoid Arthritis Treatment
What is the significance of differential use of biological drugs?
It can optimize treatment based on the pathology by stratification based on lymphocyte analysis.
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Pathophysiology and Genetic Factors
What is the role of cytokines like TNF, IL-1, and IL-6 in rheumatoid arthritis?
They cause synovitis and contribute to inflammation.
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Pathophysiology and Genetic Factors
What significant discovery was made in the late twentieth century regarding rheumatoid arthritis?
It was recognized as an autoimmune disease primarily characterized by polyarthritis.
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Future Directions in Rheumatoid Arthritis Treatment
What advancements are expected in the future treatment of rheumatoid arthritis?
Safer and more effective treatments, drug holidays, and precision medicine.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What are some adverse reactions to methotrexate?
Liver dysfunction, gastrointestinal dysfunction, myelosuppression, interstitial pneumonia, and opportunistic infections.
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Treatment Strategies and Guidelines
What is the role of glucocorticoids in rheumatoid arthritis treatment?
Recommended for temporary use to relieve pain and swelling during initial onset or relapse.
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Clinical Symptoms and Diagnosis
What was the purpose of the FIRST registry?
To treat approximately 4000 patients with biological DMARDs and evaluate contraindications and indications for their use.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What are the classifications of DMARDs?
Conventional synthetic DMARDs, targeted synthetic DMARDs, and biologic DMARDs.
p.6
Future Directions in Rheumatoid Arthritis Treatment
What is the importance of precision medicine in autoimmune diseases?
It allows for optimized use of molecular-targeted drugs according to the pathology.
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Disease-Modifying Antirheumatic Drugs (DMARDs)
What is the standard initial treatment for rheumatoid arthritis?
Methotrexate, if not contraindicated.
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Treatment Strategies and Guidelines
What should be done if no improvement is observed after 3 months of methotrexate treatment?
Add biological DMARDs or Janus kinase (JAK) inhibitors.
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Biologic and Targeted Synthetic DMARDs
In which patients should JAK inhibitors not be used?
Patients with serious infections, liver disorders, renal disorders, or blood cell disorders.
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Extra-Articular Manifestations
What are the common causes of death in Japanese patients with rheumatoid arthritis?
Respiratory dysfunction, renal failure, and infection.
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Pathophysiology and Genetic Factors
What environmental factors can modulate the epigenome in rheumatoid arthritis?
Smoking, gingivitis, and intestinal bacterial flora.
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Clinical Symptoms and Diagnosis
Which joints are most commonly affected by rheumatoid arthritis?
Joints of the fingers, toes, knees, feet, hands, elbows, and cervical spine.
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Clinical Symptoms and Diagnosis
What is the importance of early diagnosis and treatment in rheumatoid arthritis?
To prevent irreversible joint deformation and physical dysfunction.
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Biologic and Targeted Synthetic DMARDs
What should be done before using JAK inhibitors?
Screening should be performed before their use and monitoring during treatment.
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Biologic and Targeted Synthetic DMARDs
Who should administer JAK inhibitors?
They should be administered by physicians who can perform systemic management in case of adverse events.
p.3
Clinical Symptoms and Diagnosis
How is joint destruction quantitatively assessed in rheumatoid arthritis?
Using the total Sharp score calculated from radiographic findings.
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Clinical Symptoms and Diagnosis
What role do anti-cyclic citrullinated peptide (anti-CCP) antibodies play in rheumatoid arthritis?
They are highly disease-specific and indicate a higher likelihood of bone or cartilage destruction.
p.7
Disease-Modifying Antirheumatic Drugs (DMARDs)
What are DMARDs used for in the treatment of rheumatoid arthritis?
To suppress immune abnormalities and control disease activity.
p.7
Future Directions in Rheumatoid Arthritis Treatment
What is the expected future direction in the treatment of rheumatoid arthritis?
Safer and more effective treatments, therapeutic strategies aiming at cure, and the introduction of precision medicine.
p.6
Long-term Management and Drug Holidays
What are the concerns regarding long-term use of biological DMARDs?
Medical expenses and the unknown safety of long-term target inhibition.
