Which of the following cells are involved in the pathogenesis of rheumatoid arthritis?

Which of the following cells are involved in the pathogenesis of rheumatoid arthritis?

1. B cell2. T cell3. Macrophage4. All of above

Which of the followings is not anti-TNF?

1. Rituximab2. Etanercept3. Adalimumab4. Golimumab

DAS-28 is used to assess the disease activity of which disease?

1. systemic lupus erythematosus2. rheumatoid arthritis3. ankylosing spondylitis4. osteoporosis

The following side effects are increased with anti-TNF therapy except

1. Infection 2. Tuberculosis3. Hepatits B4. Lymphoma

The TB incidence rate in Taiwan is around

1. 10-24 /100,000 population2. 24-49/ 100,000 population 3. 50-100/100,000 population4. 100-299/100,000 population

Which is the correct statement regarding screen tests TST (tuberculin skin test) and IGRA (interferon-r release assay) for latent TB infection ?

1. TST is of better sensitivity than IGRA2. IGRA is of better sensitivity than TST3. TST is of better specificity than IGRA4. IGRA is of better specificity than TST

Which of the following treatment carries the highest risk of HBV reactivation

1. Methotrexate2. Steroid3. Anti-TNF plus steroid4. Rituximab plus steroid

Which of the following antiviral drugs carry the higher risk of emergence of HBV mutant variant?

1. Lamivudine2. Adefovir3. Entecavir4. Telbivudine

Which of the following cells are involved in the pathogenesis of rheumatoid arthritis?

1. B cell2. T cell3. Macrophage4. All of above

Choy EH, Panayi GS. N Engl J Med 2001;344:907-916

Cytokine signalling pathways involved in RA

11

RF

Plasma cell

B cell

Synovium

Osteoclast

OPGL

Fibroblast

IL-4IL-6

IL-10

IL-4IL-10

IFNgIL-12

ThO

IFNg

CD69 CD11

CD4 + T cellCD11

CD69TNFIL-1IL-6

MacrophageTh2

Production of metalloproteinases and other effector molecules

Migration of polymorphonuclear cells

Erosion of bone and cartilage

Chondrocyte

EtanerceptInfliximab

AdalimumabGolimumabCertolizuma

bRituximab

Tocilizumab

Tocilizumab

Abatacept

Which of the followings is not anti-TNF?

1. Rituximab2. Etanercept3. Adalimumab4. Golimumab

Woodrick, R. S. & Ruderman, E. M. Nat. Rev. Rheumatol. 7, 639–652 (2011)

DAS-28 is used to assess the disease activity of which disease?

1. systemic lupus erythematosus2. rheumatoid arthritis3. ankylosing spondylitis4. osteoporosis

Measures of disease activity of rheumatoid arthritis DAS-28, SDAI, CDAI

1. Remission (緩解 ) 2. Low disease activity (低度疾病活動度 ) 3. Moderate disease activity (中度疾病活動度 ) 4. High disease activity (重度疾病活動度 )

The following side effects are increased with anti-TNF therapy except

1. Infection 2. Tuberculosis3. Hepatits B4. Lymphoma

The TB incidence rate in Taiwan is around

1. 10-24 /100,000 population2. 24-49/ 100,000 population 3. 50-100/100,000 population4. 100-299/100,000 population

Taiwan 66.7

Hong Kong 77

China 102

Phillipines 296

臺灣仍是結核病中度流行區結核病例報告率為西元 2004年之每十萬人 74例至2007每十萬人 85例 ; 在 2010年則降為每十萬人57例

Malaysia 106

S. Korea 87

N. Korea 178

Singapore 41 Japan 31

Australia 5.7

Guam 60

Thailand 142

Indonesia 285

USA 4.6 Canada 5.5

UK 12 S. Africa 536

Vietnam 178Every 100,000 people

Data From WHO: World TB Report 2005

Which is the correct statement regarding screen tests TST (tuberculin skin test) and IGRA (interferon-r release assay) for latent TB infection ?

1. TST is of better sensitivity than IGRA2. IGRA is of better sensitivity than TST3. TST is of better specificity than IGRA4. IGRA is of better specificity than TST

A recent meta-analysis: QFT assay has high specificity (96%), whereas TST has low specificity in BCG-vaccinated people (Ann

Intern Med 2008;149:177-84 )

TST

QFT

SpecificitySensitivity

Which of the following treatment carries the highest risk of HBV reactivation

1. Methotrexate2. Steroid3. Anti-TNF plus steroid4. Rituximab plus steroid

Hepatitis flares in HBsAg (-) NHL patients Hui CK et al:

Gastroenterology 2006; 131: 59-68

• A retrospective study of 244 HBsAg (-) lymphoma patients

• 8 patients developed hepatitis (median follow-up 12.4 months)

• 3 fulminant hepatitis

6/49 12%

Which of the following antiviral drugs carry the higher risk of emergence of HBV mutant variant?

1. Lamivudine2. Adefovir3. Entecavir4. Telbivudine

24

Cumulative Incidence of HBV Resistance

J Hepatol 2009; 50: 227–42.

lamivudine adefovir entecavir telbivudine tenofovir