Question 1
A 36 year old female is referred to the rheumatology clinic from a general practitioner with 6 weeks of small joint polyarthritis with synovitis. She is Rh factor + and anti-CCP positive. X-rays of her hands show junta-articular osteoporosis with evidence of erosive disease and pannus formation. Her GP has already commenced her on naproxen. Her CRP and ESR are raised. She does not drink any alcohol and her liver function tests are normal. Which of the following is the most appropriate step in her management?
(A) switch to indomethacin
(B) initiate infliximab
(C) initiate adalumumab
(D) methotrexate
(E) methotrexate in combination with corticosteroids
E: She needs DMARDS, and biological DMARDS should be used after traditional DMARDS have failed. The anti-TNF alpha blockers all have similar efficacy in rheumatoid arthritis. Because she has active synovitis, it is important to control her inflammation with corticosteroids, however this is not a disease modifying agent. Biological dMARDS would be started if there is no remission despite an adequate 6 month course of non-biological dMARDS. RPA course 2015
Question 2
Apart from erosions, what is the strongest prognostic predictor in rheumatoid arthritis?
(A) Rf +
(B) anti-CCP +
(C) dsDNA +
(D) number of joints involved
(E) large joint involvement
B: RPA course 2015
Question 3
What is the time frame within which live attenuated vaccines must be withheld from patients who are undertaking a course of anti-TNF alpha biological therapy?
(A) 2 weeks before and 2 months after course
(B) 3 weeks before and 3 months after course
(C) 4 weeks before and 4 months after course
(D) 5 weeks before and 5 months after course
(E) 6 weeks before and 6 months after course
B: Note that influenza vaccination during this period is not contra-indicated. Med J Aust 2005;183:205-8
Question 4
Which medication requires cholestyramine washout?
(A) leflunomide
(B) methotrexate
(C) cyclophosphamide
(D) etoposide
(E) natalizumab
A: Leflunomide is a prodrug, its active drug is teriflunomide. It has a half life of 2 - 4 weeks going to significant enterohepatic metabolism of its active metabolite. Australian Prescriber 2013, vol 36 (1), RPA course 2015
Question 5
Which of the following is NOT a well known side-effect of hydroxychloroquine?
(A) retinal toxicity
(B) alopecia
(C) nausea
(D) bloating
(E) headace
E: Australian Prescriber 2003 26(2)
Question 6
Which of the following is an absolute contra-indication to the use of tocalizumab?
(A) pre-treatment with rituximab
(B) recent administration of pneumococcal vaccination
(C) diverticulosis
(D) Elevated AST/ ALT
(E) anti-TNA alpha antibodies
C: Bowel perforations are a risk factor of tocalizumab, as is dyslipidaemia Aust Prescr 2009;32:112-5
Question 7
Which of the following is NOT part of the new classification criterion for rheumatoid arthritis according to the American College of Rheumatology?
(A) Acute phase reactants
(B) Serology (Rheumatoid factor or ACPA)
(C) Duration of symptoms
(D) Pattern of joint involvement
(E) Response to anti-inflammatories
E ARTHRITIS & RHEUMATISM, Vol. 62, No. 9, September 2010, pp 2569–2581
A 36 year old female is referred to the rheumatology clinic from a general practitioner with 6 weeks of small joint polyarthritis with synovitis. She is Rh factor + and anti-CCP positive. X-rays of her hands show junta-articular osteoporosis with evidence of erosive disease and pannus formation. Her GP has already commenced her on naproxen. Her CRP and ESR are raised. She does not drink any alcohol and her liver function tests are normal. Which of the following is the most appropriate step in her management?
(A) switch to indomethacin
(B) initiate infliximab
(C) initiate adalumumab
(D) methotrexate
(E) methotrexate in combination with corticosteroids
E: She needs DMARDS, and biological DMARDS should be used after traditional DMARDS have failed. The anti-TNF alpha blockers all have similar efficacy in rheumatoid arthritis. Because she has active synovitis, it is important to control her inflammation with corticosteroids, however this is not a disease modifying agent. Biological dMARDS would be started if there is no remission despite an adequate 6 month course of non-biological dMARDS. RPA course 2015
Question 2
Apart from erosions, what is the strongest prognostic predictor in rheumatoid arthritis?
(A) Rf +
(B) anti-CCP +
(C) dsDNA +
(D) number of joints involved
(E) large joint involvement
B: RPA course 2015
Question 3
What is the time frame within which live attenuated vaccines must be withheld from patients who are undertaking a course of anti-TNF alpha biological therapy?
(A) 2 weeks before and 2 months after course
(B) 3 weeks before and 3 months after course
(C) 4 weeks before and 4 months after course
(D) 5 weeks before and 5 months after course
(E) 6 weeks before and 6 months after course
B: Note that influenza vaccination during this period is not contra-indicated. Med J Aust 2005;183:205-8
Question 4
Which medication requires cholestyramine washout?
(A) leflunomide
(B) methotrexate
(C) cyclophosphamide
(D) etoposide
(E) natalizumab
A: Leflunomide is a prodrug, its active drug is teriflunomide. It has a half life of 2 - 4 weeks going to significant enterohepatic metabolism of its active metabolite. Australian Prescriber 2013, vol 36 (1), RPA course 2015
Question 5
Which of the following is NOT a well known side-effect of hydroxychloroquine?
(A) retinal toxicity
(B) alopecia
(C) nausea
(D) bloating
(E) headace
E: Australian Prescriber 2003 26(2)
Question 6
Which of the following is an absolute contra-indication to the use of tocalizumab?
(A) pre-treatment with rituximab
(B) recent administration of pneumococcal vaccination
(C) diverticulosis
(D) Elevated AST/ ALT
(E) anti-TNA alpha antibodies
C: Bowel perforations are a risk factor of tocalizumab, as is dyslipidaemia Aust Prescr 2009;32:112-5
Question 7
Which of the following is NOT part of the new classification criterion for rheumatoid arthritis according to the American College of Rheumatology?
(A) Acute phase reactants
(B) Serology (Rheumatoid factor or ACPA)
(C) Duration of symptoms
(D) Pattern of joint involvement
(E) Response to anti-inflammatories
E ARTHRITIS & RHEUMATISM, Vol. 62, No. 9, September 2010, pp 2569–2581