Clin: RA, Seronegative Arthropathies, and Gout

Question 1

Which skin manifestation presents as a tender reddish purple papule; leading to a necrotic, non-healing ulcer?

Answer 1

Pyroderma Gangrenosum

Question 2

What are 3 toxicities you must consider when using the pyrimidine antagonist, Leflunomide, for tx RA?

Answer 2

GI + Hepatic toxicity + teratogenic!

Question 3

Vertebral involvement of RA has a predilection for which spinal segment?

Answer 3

C1-C2

Question 4

Which lab values are used to monitor the tx response in RA?

Answer 4

Acute phase reactants: ESR and CRP

Question 5

Which predisposing factor incrases the risk for severe RA?

Answer 5

Genetic factors: HLA-DRB4

Question 6

What is the most common inflammator disorder of the axial skeleton?

Answer 6

Ankylosing Spondylitis

Question 7

Which score using the 2010 RA classification criteria indicates definite RA?

Answer 7

>6/10

Question 8

Uric acid lowering agents i.e., xanthine oxidase inhibitors and uricosuric drugs should be used when?

Answer 8

• Recurrent gouty attacks, tophi, kidney stones, cytotoxic therapy
• Do NOT start during acute gout attack; can precipitate flare

Question 9

RA is an independent risk factor for which CV manifestation?

Answer 9

CAD –> chronic endothelial inflammation - damage

Question 10

What are the 3 major arthritic clinical manifestations of Reactive Arthritis?

Answer 10

• Arthritis: asymmetrical, oligo-arthritis, LE’s (ankles and knees)
• Enthesitis: achilles tendon/plantar fasciitis
• Dactylitis: sausage digit; fingr or toe

Question 11

Which PE test can help aid in the diagnosis of Ankylosing Spondylitis?

Answer 11

• Restricted forward flexion = Schober Test: ↓ lumbar spine mobility
• FABER test
• Restricted chest expansion

Question 12

Which pharmacologic agents can decrease the inflammation of the axial spine and improve mobility in pt’s with Ankylosing Spondylitis?

Answer 12

TNF-alpha blockers: Infliximab, Adalimumab

Question 13

What are some of the late complications which may arise with Ankylosing Spondylitis?

Answer 13

• Cauda equina syndrome
• Compression fractures
• Restrictive lung disease

Question 14

2010 RA classification criteria includes what 4 categories?

Answer 14

• Joint involvement: # of joints and size (smaller = more points)
• Serology: RF and anti-CCP
• Acute phase reactants: CRP and ESR
• Duration of sx’s: <6 weeks or >6 weeks

Question 15

Which imaging modality is most sensitive for detecting erosions and which is able to detect inflammation earliest?

Answer 15

• CT = more sensitive for erosions
• MRI = detects inflammation before changes seen on X-ray and CT

Question 16

Which disease manifestation of the eye can be seen with Ankylosing Spondylitis?

Answer 16

Anterior uveitis = Iritis

Question 17

What is the hallmark of spondyloarthropathy in children?

Answer 17

Enthesitis: inflammation at sites where tendons, ligaments and joint capsule insert into bone