1. IIIB – DOCTOR OF MEDICINE B5 Dr. Tan - Ong

2. ACR classification criteria Morning stiffness Arthritis of three or more joint areas Arthritis of hand joints Symmetric arthritis Rheumatoid nodules Serum rheumatoid factor Radiographic changes Stiffness in and around the joints lasting 1 h before maximal improvement. 14 possible joint areas involved are right or left proximal interphalangeal, metacarpophalangeal, wrist, elbow, knee, ankle, and metatarsophalangeal joints. Arthritis of wrist, metacarp ophalang eal joint, or proximal interphala ngeal joint Simultaneous involvement of the same joint areas on both sides of the body. Subcutaneous nodules over bony prominences, extensor surfaces, or juxtaarticular regions observed by a physician. Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in less than 5% of normal control subjects. RA on posteroanterior hand and wrist radiographs that must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints.

3.  Congestive Heart Failure  Collagen Vascular Diseases  SLE, RA, Scleroderma, PAN  Infectious Pericarditis  Coxsackie Virus and TB  Post – Operative  Post – Myocardial Infarction  Dressler’s Syndrome  Trauma  Malignant Disease  Direct Extension or Metastasis  Uremia  Radiation Treatment  Chemotherapy  Doxorubicin and Cyclophosphamide  Hypothyroidism  Bleeding Diatresis  Idiopathic Pericarditis  Drugs  Hydralazine, Isoniazid, Phenytoin  HIV/AIDS SOURCE: http://www.mypacs.net/cases/PERICARDIAL- EFFUSION-1416531.html

4.  quantification of interferon-gamma (IFN- γ) released from sensitized lymphocytes in whole blood incubated overnight with purified protein derivative (PPD) from M. tuberculosis and control antigens Mazurek, Gerald, and Margarita Villarion. "Guidelines for Using the QuantiFERON®-TB Test for Diagnosing Latent Mycobacterium tuberculosis Infection." Morbidity and Mortality Weekly Report. 01 Jan 2003. Centers for Disease Control and Prevention, Web. 7 Dec 2009.

5.  Anti-TNF therapies, which target the protein TNF, have improved the lives of many with inflammatory diseases such as rheumatoid arthritis. However, the treatment has been known to leave these patients with a decreased ability of the immune system to fight infections and has been associated with an increased incidence of TB.  A subset of CD8-expressing effector memory immune T cells characterized by expression of the proteins CD45RA and granulysin were identified as having a major role in targeting the bacterium that causes tuberculosis (Mycobacterium tuberculosis).  Furthermore, numbers of CD45RA+ effector memory CD8+ T cells were reduced in patients following treatment with infliximab. As this correlated with a decreased ability of peripheral blood from the patients to kill M. tuberculosis, it is concluded that the loss of this immune cell subset provides a mechanism to explain the reactivation of latent tuberculosis infection in some individuals being treated with infliximab. http://www.medindia.net/news/Anti-TNF-Therapies-Linked-With-Increased- Tuberculosis-Risk-50286-1.htm