Musculoskeletal

Question 1

Define rheumatoid arthritis

Answer 1

Inflammatory systemic disease causing symmetrical deforming polyarthritis and extra-articular manifestations

Question 2

Explain the aetiology / risk factors of rheumatoid arthritis

Answer 2

Autoimmune disease of unknown cause

Associated with Raynaud’s and Sjӧgren’s Syndrome and HLA DR-1 and HLA DR-4

Question 3

Summarise the epidemiology of rheumatoid arthritis

Answer 3

Common, 1% of population, more in females

Question 4

Recognise the presenting symptoms of rheumatoid arthritis

Answer 4

Gradual onset:
Joint pain, swelling, morning stiffness and impaired function
Usually affecting peripheral joints symmetrically

Question 5

Recognise the signs of rheumatoid arthritis on physical examination

Answer 5

Arthritis, in the hands
Early:
- Spindling of fingers
- Swelling at MCP and PIPs
- Warm, tender joints
- Reducting in movement range
Late:
- Symmetrical deforming arthropahy
- Ulnar deviation of fingers, resulting from a partial dislocation at MCP
- Radial deviation of the wrist
- Swan neck deformity (MCP and PIP extended, DIP flexed)
- Boutonniere deformity (MCP exte

Question 6

Identify appropriate investigations for rheumatoid arthritis and interpret the results

Answer 6

Blood: FBC, ESR, CRP, rheumatoid factor, ANA
Joint aspiration: acutely, to exclude septic arthritis
Joint X-Ray: DONS
- Deformity of joint
- Osteopaenia
- Narrowing of joint space
- Swelling of soft tissue
Flety’s Syndrome (SANTA): Splenomegaly, Arthritis, Neutropaenia, Thrombocytopaenia, Anaemia