MIDTERMS: Rheumatoid Arthritis & Rheumatic disease in children Flashcards
Q: What is rheumatoid arthritis (RA)?
A: A chronic autoimmune disease that causes symmetric inflammatory arthritis affecting multiple joints.
Q: What genetic factor is associated with RA?
A: HLA-DR4.
Q: What is the hallmark of RA?
A: Synovial inflammation and pannus formation, leading to cartilage and bone destruction.
Q: What is the female-to-male ratio in RA?
A: 3:1 (more common in females).
Q: What age group is most affected by RA?
A: Peak onset is 35-50 years old.
Q: What are the joint deformities seen in RA?
Ulnar deviation.
Boutonnière deformity (PIP flexion, DIP hyperextension).
Swan neck deformity (PIP hyperextension, DIP flexion).
Z-thumb deformity.
Q: What are the early symptoms of RA?
Morning stiffness >1 hour.
Pain and swelling in small joints (MCP, PIP, wrists).
Fatigue and malaise.
Q: What are the extra-articular manifestations of RA?
Skin: Rheumatoid nodules, vasculitis.
Lungs: Pulmonary fibrosis, pleural effusion.
Heart: Pericarditis, atherosclerosis.
Eyes: Keratoconjunctivitis sicca, episcleritis.
Kidneys: Amyloidosis.
Nervous system: Carpal tunnel syndrome, mononeuritis multiplex.
Q: What is Felty’s Syndrome?
A: RA + splenomegaly + neutropenia.
Q: What are the diagnostic criteria for RA (ACR/EULAR 2010)?
Joint involvement – Small joints are affected.
Serology – RF or Anti-CCP positive.
Acute phase reactants – Elevated ESR or CRP.
Symptoms lasting >6 weeks.
Q: What laboratory tests help diagnose RA?
Rheumatoid Factor (RF) – Present in 85% of cases.
Anti-CCP antibodies – More specific than RF.
ESR & CRP – Indicate inflammation.
Q: What are radiographic features of RA?
Periarticular osteopenia.
Symmetric joint space narrowing.
Marginal erosions.
Q: What is the first-line treatment for RA?
A: Methotrexate (MTX) – A disease-modifying anti-rheumatic drug (DMARD).
Q: What are biologic therapies used in RA?
A: TNF inhibitors (Etanercept, Infliximab, Adalimumab).
Q: What antibody is often positive in JIA, especially with oligoarthritis?
A: Antinuclear Antibodies (ANA).
Q: What are non-pharmacologic treatments for RA?
Physical & occupational therapy.
Joint protection techniques.
Assistive devices (splints, braces).
Q: What is the most common chronic arthritis in children?
A: Juvenile Idiopathic Arthritis (JIA).
Q: What are the criteria for diagnosing JIA?
Onset before age 16.
Symptoms lasting at least 6 weeks.
No other known cause
Q: What serious complication can occur in systemic JIA?
A: Macrophage Activation Syndrome (MAS) – Life-threatening, with fever, splenomegaly, pancytopenia, liver dysfunction.
Q: What are the major types of JIA?
Systemic Arthritis (Still’s Disease) – Fevers, rash, organ involvement.
Oligoarthritis – < 4 joints, mostly large joints.
Polyarthritis – > 4 joints, resembles adult RA.
RF-negative Arthritis – Similar to adult RA but no RF.
RF-positive Arthritis – More aggressive, similar to adult RA.
Psoriatic Arthritis – Arthritis + psoriasis or nail changes.
Enthesitis-Related Arthritis – Involves tendons & ligaments, associated with HLA-B27.
Undifferentiated Arthritis – Does not fit other categories.
Q: What are the long-term complications of JIA?
Growth disturbances (overgrowth or undergrowth of affected limbs).
Leg length discrepancies.
Hip developmental anomalies.
Q: What are the early symptoms of JIA?
Joint swelling & warmth.
Morning stiffness.
Fluctuating symptoms.
Q: What is the most common eye complication in JIA?
A: Iridocyclitis (uveitis) – Can lead to blindness if untreated.
Q: What is Still’s Disease?
A: A severe systemic form of JIA with fevers, rash, and organ involvement.
Q: What are the subtypes of oligoarthritis in JIA?
Persistent – Affects ≤4 joints.
Extended – Affects >4 joints over time.
Q: What is the classic triad of psoriatic arthritis in children?
Arthritis.
Dactylitis (sausage fingers/toes).
Nail pitting.
Q: What are the hallmarks of enthesitis-related arthritis?
Arthritis affecting the lower extremities.
Inflammation at the Achilles tendon & plantar fascia.
HLA-B27 association.
Q: What serious progression can occur with enthesitis-related arthritis?
A: Ankylosing spondylitis.
Q: What are the first-line medications for JIA?
A: NSAIDs for symptom control.
Q: What medications are used in severe cases of JIA?
A: Methotrexate or Biologics (TNF inhibitors, IL-1 inhibitors).
Q: What is the role of physical therapy in JIA?
Maintains joint mobility.
Prevents contractures.
Strengthens muscles around joints.
