Case Based Rheum

Question 1

Answer 1

Sometimes MRI or ultrasound are needed to pick up early erosions

A consistenly elevated ESR is assoicated with bad prognosis

Question 2

Answer 2

Notes about treatment in RA:

anti-TNF agents are contraindicated in a patient with melanoma, may have to use hydroxycholoroquine+ methotrexate + sulfaphazine (these 3 drugs together have been shown to be as effective as anti-TNF agents in controlling RA)

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Question 4

What tests should be performed before starting anti-TNF therapy?

Answer 4

TB and HEP B/C

CXR for granulomas in the lungs

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Most sensitive test for RA?

Answer 6

anti-CCP has 98% specificity

RF is much less specific and only about 60% sensitive

other Abs: ANA (not specific)

HLAB27 in seronegative arthritis

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Can only give hydroxycloroquine and prednisone

Cant give methotrexate and Leflunomide other azathioprine

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What are the typical feature sof inflammatory back pain?

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