Johnston: RA, Seronegative Arthropathies, and Gout

Question 1

Which predisposing factor incrases the risk for severe RA?

Answer 1

Genetic factors: HLA-DRB4

Question 2

2010 RA classification criteria includes what 4 categories?

Answer 2

• 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 3

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

Answer 3

>6/10

Question 4

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

Answer 4

Acute phase reactants: ESR and CRP

Question 5

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

Answer 5

C1-C2

Question 6

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

Answer 6

Pyroderma Gangrenosum

Question 7

RA is an independent risk factor for which CV manifestation?

Answer 7

CAD –> chronic endothelial inflammation - damage

Question 8

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

Answer 8

GI + Hepatic toxicity + teratogenic!

Question 9

What is the hallmark of spondyloarthropathy in children?

Answer 9

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

Question 10

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

Answer 10

Ankylosing Spondylitis

Question 11

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

Answer 11

Anterior uveitis = Iritis

Question 12

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

Answer 12

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

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

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

Answer 14

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

Question 15

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

Answer 15

TNF-alpha blockers: Infliximab, Adalimumab

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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