JM Chapter 25

Question 1

is an abnormality of uric acid metabolism resulting in hyperuricaemia and urate crystal
deposition.

Urate crystals deposit in:

joints acute gouty arthritis

soft tissue- tophi and tenosynovitis

urinary tract-urate stones

Answer 1

Gout (monosodium urate crystal disorder)

Question 2

Tx for RF

Answer 2

Question 3

is
usually associated with stiffness, especially after activity,

Pain: worse by the end of the day, aggravated by use, relieved by rest, worse in cold and damp

Variable morning stiffness

Hard and bony swelling

Crepitus

Signs of inflammation (mild), warmth, pain

Restricted movements; inability to weight bear
Joint deformity

Answer 3

Osteoarthritis

Question 4

If the RA factor is positive, it is non-specific-
What to order to
confirm the diagnosis.

Answer 4

, anti-CCP antibody

Question 5

is the ‘backbone’ of treatment of RA, and should be continued when starting other
DMARDS.

cornerstone of management In most patients with recently
diagnosed RA,

Answer 5

Methotrexate

Initial dose: methotrexate 5-10 mg (o) once weekly on a specified day,

increasing to maximun
of 25 mg weekly or SC depending on clinical response and toxicity. Add folic acid 5-10 mg
twice weekly (not on the day methotrexate is given).

Question 6

Supplementation with . can improve gastrointestinal symptoms and reduce the risk of
liver dysfunction.

Answer 6

Folic acid

Question 7

appropriate for flares of RA.

Answer 7

Glucocorticoids

Question 8

Combination therapy
Consider standard triple therapy: RA

Answer 8

methotrexate + sulfasalazine + hydroxychloroquine

Question 9

‘sausage finger’ pattern.

can present as a polyarthritis affecting the fingers of the hand

Answer 9

Scleroderma

Question 10

The three main types of crystal arthritis

Answer 10

monosodium urate (gout), calcium
Pyrophosphate dihydrate (CPPD) and calcium phosphate (usually hydroxyapatite).27

Question 11

Morning stifness and pain, improving with exercise

Answer 11

RA.

Question 12

If a patient returns from overseas with arthralgia, think of drug reactions, hepatitis
Lyme disease, but if the pain is intense consider

Answer 12

dengue fever.

Question 13

Consider the possibility of .what disease in people with a fever, rash and arthritis
who have been exposed to tick bites overseas.

Answer 13

Lyme disease

Question 14

This usually presents with an insidious onset of inflammatory back and buttock pain (sacroiliac
joints and spine) and stiffness in young adults (age <40 years), and 20% present with peripheral
joint involvement before the onset of back pain.

Answer 14

Ankylosing spondylitis

Question 15

DXT urethritis + conjunctivitis + iritis + arthritis

Answer 15

reactive arthritis

Question 16

is a form of arthropathy in which non-septic arthritis and often sacroilitis
develop after an acute urogenital infection (usually Chlamydia trachomatis) or an enteric
infection (e.g. Salmonella, Shigella).

Answer 16

Reactive arthritis