Hand Questions

Question 1

RA Stats

Answer 1

3 females: 1 male

Peak prevalence age 30-50

70% seropositive

20% have nodules

50% HLA-DR4 +ve

Question 2

Features of active RA

Answer 2

Inflamed joints: red, hot, swollen, tender

Pain on passive movement

Increased duration of moving stiffness

Raised ESR

Anaemia

Question 3

Extra-articular features of RA

Answer 3

General: malaise, lethargy, low grade fever, weight loss
CVS: pericarditis, pericardial effusion
RS: nodules, pleural effusion, pulmonary fibrosis, pneumoconiosis
GUS: renal amyloid
NS: polyneuropathy, mononeuritis multiplex, carpal tunnel
Eyes: scleritis, episcleritis, Sjorgen’s syndrome
Blood: anaemia, thrombocytotosis, low WCC

Question 4

Multifactorial aetiology of anaemia in RA

Answer 4

Anaemia of chronic disease
Iron deficiency anaemia secondary to NSAID-induced gastritis / peptic ulcer
Aplastic anaemia secondary to DMARD
Macrocytic anaemia secondary to methotrexate
Pernicious anaemia

Question 5

RA X-ray

Answer 5

Loss of joint space
Bony erosions
Periarticular osteoporosis
Deformity 
Soft tissue swelling

Question 6

OA X-ray

Answer 6

Loss of joint space
Osteophytes
Subchondral sclerosis
Bone cysts

Question 7

Psoriatic arthropathy

Answer 7

Asymmetrical oligoarthritis - mainly hands and feet (dactylitis), sometimes larger joints
Lone DIP disease
Rheumatoid pattern
Arthritis mutilans
Sacroiliitis

Question 8

Sjorgen’s syndrome

Answer 8

May occur independently
May be associated with RA / SLE / scleroderma
Features: dry eyes (keratoconjunctivitis sicca), dry mouth (xerostomia), parotid gland enlargement

Question 9

DMARDs and key side effects

Answer 9

All DMARDs: myelosuppression, hepatoxicity, rash, GI upset
Methotrexate: pneumonia & pulmonary fibrosis, megaloblastic anaemia
Hydroxychloroquine: retinopathy
Sulfalazine: oligospermia

Question 10

T1 lesion

Answer 10

Aetiology: cervical spondylosis, pancoast tumour, plexus trauma / birth injury

Clinical features: total claw hand (all lumbricals lost), wasting of small muscles of hand, pain / sensory loss in medial forearm, Horner’s syndrome may co-exist

Question 11

Carpal Tunnel Syndrome

Answer 11

Idiopathic (majority of case)
Pregnancy
RA
Hypothyroid
Diabetes
Acromegaly