22 - Rheumatoid Arthritis

Question 1

Definition of rheumatoid arthritis?

Answer 1

Active symmetrical arthritis lasting more than 6 weeks (3 criteria in there)

Question 2

Who is rheumatoid arthritis most common in?

Answer 2

Females

Most patients present in their 40s & 50s

Question 3

Characteristic clinical picture of rheumatoid arthritis?

Answer 3

Bilateral joint pain and swelling
Reduction in range of motion and joints are warm/tender to touch

Joints RA particularly affects:
- metacarpophalangeal
- proximal interphalangeal
- metatarsophalangeal
Bilaterally!!

Question 4

Which antibody is most commonly positive in rheumatoid arthritis and in what proportion of patients?

Answer 4

Anti-cycli citrullinated peptide (anti-CCP)

- positive in 80% RA patients

Question 5

Why ESR and joint ultrasound not indicated as initial investigations of rheumatoid arthritis?

Answer 5

ESR - can be useful as a baseline prior to treatment but is normal in 40% of RA patients

Joint ultrasound - can be useful to look for synovitis but would not be the initial investigation to confirm diagnosis

Question 6

What other autoantibody is present in rheumatoid arthritis and in what proportion of cases?

Answer 6

Rheumatoid Factor

- present in 60-70% cases

Question 7

2 auto-antibodies diagnostic of rheumatoid arthritis?

Answer 7

Anti-cyclic citrullinated peptide

Rheumatoid factor