Questions for CME: rheumatoid arthritis and statins.

1. The immunologic derangement characteristic of rheumatoid arthritis is:

a. Increase in Th2 cytokines, with IL-4, IL-5, and IL-10 driving inflammation

b. Increase in Th1 cytokines, with IL-1, IL-6 and TNF[alpha] driving inflammation

c. Increase in CD8+ cell-mediated immunity

2. C-reactive protein

a. Is an acute phase reactant and measure of systemic inflammation in RA

b. Is associated with cardiovascular risk in the general population

c. Decreases after treatment of active RA with TNF inhibitors

d. Decreases after treatment with statin

e. All of the above

3. Treatment with methotrexate has been found to raise cardiovascular mortality in RA.

a. True

b. False

4. Statins have been proven effective in the

a. Prevention of non-hemorrhagic stroke

b. Prevention of cardiovascular events in patients with known cardiovascular disease

c. Reduction of serum total cholesterol and LDL levels

d. Prevention of cardiovascular events in patients with known cardiovascular disease

e. All of the above

5. The reduction in cardiovascular morbidity and mortality afforded by statins is entirely explained by their beneficial effects on lipid profiles.

a. True

b. False

6. Statins' beneficial effects on endothelial function include:

a. Inhibition of endothelial nitric oxide (NO) synthase

b. Stimulation of endothelin-1 expression

c. Upregulation of decay-accelerating factor, protecting against complement-mediated endothelial injury

7. Factors associated with endothelial dysfunction include all of the following except:

a. Hypertension

b. Cigarette smoking

c. Rheumatoid arthritis

d. Aspirin use

e. Diabetes mellitus

8. Statins may act to decrease inflammation within atherosclerotic plaques.

a. True

b. False

9. Small trials have shown that statins may offer which of the following benefits to patients with RA

a. Decreased systemic inflammation

b. Improved disease activity score

c. Decreased swollen joint counts

d. Decreased cardiovascular risk

e. Improved endothelial function

f. All of the above

10. Potential side effects of statin use in patients with rheumatoid arthritis include all of the following except

a. Hepatotoxicity

b. Osteoporosis

c. Myalgias

d. Rhabdomyolysis

Answers to CME Questions

1. B, 2. E, 3. B, 4. E, 5. B, 6. C, 7. D, 8. A, 9. F, 10. B