PART A
Rheumatoid Arthritis
Text A
Rheumatoid arthritis is a chronic inflammatory disorder that
typically affects the small joints in your hands and feet. Unlike the
wear-and-tear damage of osteoarthritis, rheumatoid arthritis
affects the lining of your joints, causing a painful swelling that can
eventually result in bone erosion and joint deformity. An
autoimmune disorder, rheumatoid arthritis occurs when your
immune system mistakenly attacks your own body's tissues. In
addition to causing joint problems, rheumatoid arthritis can also
affect your whole body with fevers and fatigue.
Rheumatoid arthritis is much more common in women than in
men and generally occurs between the ages of 40 and 60.
Treatment focuses on controlling symptoms and preventing joint
damage.
Signs and symptoms of rheumatoid arthritis may include:
Tender, warm, swollen joints
Morning stiffness that may last for hours
Firm bumps of tissue under the skin on your arms (rheumatoid
nodules)
Fatigue, fever and weight loss
Early rheumatoid arthritis tends to affect your smaller joints first
— particularly the joints that attach your fingers to your hands
and your toes to your feet. As the disease progresses, symptoms
often spread to the knees, ankles, elbows, hips and shoulders. In
most cases, symptoms occur in the same joints on both sides of
your body.
The signs and symptoms of rheumatoid arthritis may vary in
severity and may even come and go. Periods of increased disease
activity, called flares, alternate with periods of relative remission
— when the swelling and pain fade or disappear. Overtime,
rheumatoid arthritis can cause joints to deform and shift out of
place.
Text B
Causes of Rheumatoid Arthritis
Rheumatoid arthritis occurs when your immune system
attacks the synovium — the lining of the membranes that
surround your joints. The resulting inflammation thickens the
synovium, which can eventually invade and destroy the
cartilage and bone within the joint. The tendons and
ligaments that hold the joint together weaken and stretch.
Gradually, the joint loses its shape and alignment. Doctors
don't know what starts this process, although a genetic
component appears likely. While your genes don't actually
cause rheumatoid arthritis, they can make you more
susceptible to environmental factors — such as infection with
certain viruses and bacteria — that may trigger the disease.
Rheumatoid arthritis is difficult to be diagnosed: Rheumatoid
arthritis can be difficult to diagnose in its early stages
because the early signs and symptoms mimic those of many
other diseases. There is no single test or physical finding to
confirm the diagnosis. During the physical exam, your doctor
will check your joints for swelling, redness and warmth and
they will also check your reflexes and muscle strength. Blood
tests: People with rheumatoid arthritis tend to have an
elevated erythrocyte sedimentation rate (ESR, or sed rate),
which indicates the presence of an inflammatory process in
the body. Other common blood tests look for rheumatoid
factors and anti-cyclic citrullinated peptide (anti-CCP)
antibodies.
X-rays: Your doctor may recommend X-rays to help track the
progression of rheumatoid arthritis in your joints over time.
Text C
Algorithm based on the Canadian Rheumatology Association (CRA)
recommendations for the pharmacological treatment of rheumatoid
arthritis (RA) with traditional and biologic disease-modifying antirheumatic
drugs (DMARD). LDA: low disease activity; DMARD: disease-modifying
antirheumatic drug; CI: contraindicated; IA: intraarticular; IM: intramuscular;
MTX: methotrexate; anti-TNF: tumor necrosis factor inhibitor; ABAT:
abatacept; RTX: rituximab; TCZ: tocilizumab.
Text D
Cure for rheumatoid arthritis: There is no cure for rheumatoid arthritis.
Medications can reduce inflammation in your joints in order to relieve pain
and prevent or slow down joint damage. Occupational and physical therapy
can teach you how to protect your joints but, if your joints are severely
damaged by rheumatoid arthritis, surgery may be necessary. Medications:
Many drugs used to treat rheumatoid arthritis have potentially serious side
effects. Doctors typically prescribe medications with the fewest side
effects first. You may need stronger drugs or a combination of drugs as your
disease progresses.
NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and
reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil,
Motrin etc.) and naproxen (Aleve). Stronger NSAIDs are available by
prescription. Side effects may include ringing in your ears, stomach
irritation, heart problems and liver and kidney damage.
Steroids Corticosteroid medications, such as prednisone, reduce
inflammation and pain and slow down joint damage. Side effects may
include thinning of bones, cataracts, weight gain and diabetes. Doctors
often prescribe a corticosteroid to relieve acute symptoms, with the goal of
gradually tapering off the medication.
Other drugs: Several other rheumatoid arthritis drugs target a variety of
processes involved with inflammation in your body. These drugs include
anakinra (kineret), abatacept (orencia), rituximab (rituxan) and tocilizumab
(actemra). Side effects vary but may include itching, severe abdominal pain,
headaches, a runny nose or sore throat
PART A
TIME: 15 minutes
⦁ Look at the four texts , A – D, in the separate Text Booklet
⦁ For each question, 1-20, look through the texts, A-d, to find the relevant
information.
⦁ Write your answers on the spaces provided in this Question Paper.
⦁ Answer all the questions within the 15-minute time limit.
RHEUMATOID ARTHRITIS
Questions 1-7
For each of the questions, 1-7, decide which text (A, B, C or D) the information
comes from. You may use any letter more than once
1. The side effects of NSAIDS include ringing in ears, stomach irritation, heart
problems and liver and kindly damage. …………………..
2. The signs and symptoms of rheumatoid arthritis may vary in severity and may
even come and go. ……………..
3. Rheumatoid arthritis occurs when your immune system mistakenly attacks
your own body’s tissues. …………….
4. There is no cure for rheumatoid arthritis. …………………..
5. X – rays to help track the progression of rheumatoid arthritis in joints.
……………..
6. Enrolling patient in a clinical trial when biologic and traditional DMARD failed.
…………..
7. Prednisone can reduce inflammation and pain and slow down joint damage.
………………
Questions 8-14
Answer each of the questions, 8-4, with a word or short phrase from one of the
texts. Each answer may include words, number of the both. Your answers should
be correctly spelled.
8. CRA stands for?
……………………………………
9. Which age group is generally affected by rheumatoid arthritis?
…………………………………………..
10. The lining of the membranes that surround joints is called as?
…………………………………………..
11. Which joints are affected first by early rheumatoid arthritis?
……………………………………………
12. Periods of increased disease activity are called as?
…………………………………………….
13. Which drug is used in DMARD monotherapy unless contraindicated?
…………………………………………….
14 What is anti-TNF refers to?
……………………………………………
Questions 15-20
Complete each of the sentences, 15- 20, with a word or
short phrase from one of the texts. Each answer may
include words, number or both. Your answers should be
correctly spelled
15. Treatment focuses on ………………………symptoms and
preventing joint damage.
16 As the disease progresses, symptoms often spread to the
knees, ankles elbows ………………… and shoulders.
17. Inflammation thickens the synovium which can
eventually invade and destroy the ……………. and bone within
the joint.
18. Rheumatoid arthritis is difficult to be diagnosed in its
early stages because the early ………………….. mimic those of
many other diseases.
19. ………………………. is disease – modifying antirheumatic drug.
20. People with rheumatoid arthritis tend to have an
elevated ---------------------- rate.
