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NBME 22 Answers

nbme22/Block 4/Question#24 (23.2 difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-α🔍
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submitted by seagull(1080),
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mI saol dnienoccv cloknibg L-I2 si slao a mtrtte?ena HyW is aahTNplF- eth teetrb esnrwa ?heer

amorah  FA P120-122. Immunosuppressants for RA are calcineurin inhibitor (cyclosporine and tacrolimus), 6MP, and TNFa inhibitors (adalimumab,infliximab, etanercept). It is important to distinguish that calcineurin inhibitors block t cell activation by preventing IL-2 transcription, not necessarily block IL-2 action. Sirolimus(rapamycin) blocks IL-2 action but it is used for kidney transplant rejection prophylaxis specifically. +11  
sbryant6  Spot on. This image explains how Sirolimus blocks the effects of IL-2: https://image.slidesharecdn.com/11-150813013011-lva1-app6892/95/11immunosuppressants-30-638.jpg?cb=1439429471 +  
krewfoo99  in addition to the above responses, IL 1 antagonists (Anakinra) can be used to treat RA. Anakinra is a recombinant human IL 1 receptor anatagonist but less effective than other treatment modalities. +  
snripper  Prednisone is a glucocorticoid (which inhibits IL-2 synthesis) is already being used with no effect. So TNF-alpha is the next option. +  
avocadotoast  DMARDs: methotrextate, sulfasalazine, hydroxychloroquine, leflunomide, TNF inhibitors, Anti- IL6 (Tocilizumab), JAK inhibitor (Tofacitinib), Rituximab. You can use cyclosporine and tacrolimus to treat RA, but those aren't first line treatments. DMARDs are used the long term treatment of RA and methotrexate is often started first, and the other drugs are prescribed if methotrexate does not sufficiently control symptoms. None of the other choices listed are a part of DMARD therapy. +  



 +0  upvote downvote
submitted by asharm10(15),

Rheumatoid arthritis in an inflammatory process, you wanna block Tnf alpha which is a major inflammation accelerator, IL 2 blockers used for tansplant rejections, because you dont want your B and T cells proliferating, IL 2 induces differentiation of all immune cells.