B3.023 - Rheumatoid Arthritis

Question 1

What is non inflammatory arthritis

Answer 1

osteoarthritis, due to mechanical wear and tear

Question 2

What is inflammatory arthritis

Answer 2

Immune system is the culprit, targeting the joints

Question 3

What are the multiple types of inflammatory arthritis

Answer 3

Rheumatoid, psoriatic, chron’s disease related

Question 4

What is the difference between primary and secondary osteoarthritis

Answer 4

Primary - due to mechanical derangement of joint

Secondary - due to trauma, genetic conditions

Question 5

What are the most common places of osteoarthritis

Answer 5

Knee
Hip
Hands

Question 6

What hand joints are the common points of osteoarthritis

Answer 6

PIPs
DIPs
Carpometacarpal (base of thumb)

Question 7

What is the prevalence of RA

Answer 7

1%

Question 8

What are the peak ages of onset of RA

Answer 8

50-75

Question 9

RA spares what finger joints

Answer 9

DIPs

Question 10

What are characteristics of presentation of RA

Answer 10

Symmetric polyarticular involvement

Upper and lower extremity involvement

Question 11

Describe the onset of stiffness in RA patients

Answer 11

Morning stiffness usually >1 hour

Question 12

Characterize morning stiffness in OA

Answer 12

<30 minutes

Question 13

What do hands of RA patients look/feel like

Answer 13

Boggy, swollen and you cant see wrinkles

Question 14

Describe the joint changes in RA patients hands

Answer 14

Ulnar deviation at MCPs
Swan neck
Boutonniere deformity
Cannot be straightened out in clinic

Question 15

What are exam clues for osetoarthritis

Answer 15

Distribution of joints particularly in DIPs
Bony appearing changes
No ulnar deviation

Question 16

What are extraarticular manifestations of RA

Answer 16

pleural effusion and pleurisy
Pulmonary nodules
Interstitial lung disease 
Pericarditis and pericardial effusion
myocarditis
Accelerated coronary artery disease

Question 17

What is rheumatoid vasculitis

Answer 17

inflammation of blood vessels leads to occlusion and ischemia

Question 18

what are extraarticular manifestations of RA in the eye

Answer 18

Secondary sjogrens/keratoconjunctivitis sicca
Episcleritis and scleritis
Corneal melt

Question 19

What are the hematologic extraarticular manifestations of RA

Answer 19

Feltys syndrome

Question 20

What is feltys syndrome

Answer 20

Splenomegaly, leukopenia, RA

Question 21

What are the neurologic extraarticular symptoms of RA

Answer 21

Carpal tunnel
Entrapment neuropathy
Spinal cord compression

Question 22

What is the strongest genetic link to RA

Answer 22

Shared epitope highly similar to AA sequence in alleles in HLA-DRB1 locus

Question 23

What environmental factors contribute to RA

Answer 23

Silica exposure (Caplans syndrome)
Smoking
Peridontal disease
Gut microbiome

Question 24

What is the relevance of Th17 in RA

Answer 24

Th17 cell is an important link with innate immune system, B cells serve as antigen presenting cells.

Question 25

What is characteristic of H&E of RA

Answer 25

Fibrovascular tissue protrudes from inflamed synovium into the articular cartilage

Question 26

How does joint destruction in RA happen

Answer 26

Osteoclasts ultimately result in erosions and join deformities

Question 27

What labs can you do to diagnose RA

Answer 27

RF CCP ANA

Question 28

What labs can you get to assist with disease activity

Answer 28

ESR, CRP

Question 29

What labs can help you with medication monitoring

Answer 29

CBC with differential Creatinine AST/ALT

Question 30

What is RF

Answer 30

Autoantibodies that recognize determinants of the Fc portion of IgG

Question 31

What is CCP

Answer 31

Anti cyclic citrullinated peptide

Question 32

seropositive v seronegative

Answer 32

Seropositive - RF or CCP positive | Seronegative - negative RF, CCP

Question 33

What is a positive RF and CCP without arthritis indicative of

Answer 33

May identify patients in early process of disease

Question 34

What can radiographs look for

Answer 34

``` periarticular osteopenia symmetric join space loss Marginal erosions soft tissue swelling no new bone formation ```

Question 35

Distinguish between RA and OA on physical exam

Answer 35

RA - swelling, warm, erythema | OA - Bony changes

Question 36

Distinguish between morning stiffness between RA and OA

Answer 36

RA - >1 hour | OA - <1 hour

Question 37

Does OA have systemic symptoms?

Answer 37

No

Question 38

Does RA have systemic symptoms?

Answer 38

It can

Question 39

Distinguish between labs for RA and OA diagnosis

Answer 39

RA - +CCP/RF, elevated inflammatory markers | OA - normal findings

Question 40

Describe findings on a radiograph for RA

Answer 40

Erosions, periostitis, joint-space narrowing

Question 41

Describe findings on a radiograph in OA

Answer 41

Joint space narrowing, osteophytes, subchondral sclerosis