OnlineMedEd - Rheumatology: Rheumatoid Arthritis

Question 1

True or false: rheumatoid arthritis more commonly presents in young people.

Answer 1

False. It is more common in middle age and older.

Question 2

Basically, rheumatoid arthritis is an ______________ disorder that results in the formation of _____________.

Answer 2

autoimmune; pannus (inflammatory cells in the synovium)

Question 3

Rheumatoid arthritis has a predilection for the _________ joints.

Answer 3

small (particularly the hands and feet)

Question 4

In order to have a true diagnosis of rheumatoid arthritis, you need to have more than ____________ joints involved.

Answer 4

two

Question 5

Rheumatoid arthritis is always _____________ (a type of body distribution).

Answer 5

symmetric

Question 6

Rheumatoid arthritis always spares the _____________.

Answer 6

DIPs

Question 7

Morning stiffness, a classic feature of rheumatoid arthritis, must be present for greater than ______________.

Answer 7

60 minutes

Osteoarthritis is less than 60 minutes.

Question 8

_____________ are a pathognomonic finding of RA.

Answer 8

Nodules (though they’re usually found late in the disease course)

Question 9

If you biopsy the nodules found in rheumatoid arthritis, you’ll see ______________.

Answer 9

cholesterol

Question 10

Anti-CCP antibodies are more ___________ for rheumatoid arthritis, while rheumatoid factor is more ______________.

Answer 10

specific; sensitive

Question 11

_________ is the preferred imaging modality for identifying RA. “____________” is the big radiological buzzword.

Answer 11

X-ray; Periarticular osteopenia

Question 12

Discuss the four pillars of RA treatment.

Answer 12

• NSAIDs: to be used intermittently for symptom control
• DMARDs (like methotrexate): to be used in all patients with RA
• Biologic agents (TNF-alpha inhibitors and CD20 antibodies): to be used for refractory, severe RA
• Steroids: for flare ups

Question 13

Do not be tricked by this: ________ should never be used as monotherapy.

Answer 13

NSAIDs

This can be difficult because a question might describe a patient with very mild RA (no erosions, etc.). In this case, the patient should still get DMARDs like methotrexate that will prevent the disease from progressing.

Question 14

Methotrexate is to RA what ___________ is to lupus.

Answer 14

hydroxychloroquine

Question 15

Prior to initiating biologic agents for RA, you need to ask a patient if _________________.

Answer 15

(1) they’ve been vaccinated, (2) they have been tested for TB, and (3) they have been to areas with endemic fungi (like Blastomyces in the Ohio River Valley)

Question 16

You should attempt to ______________ before progressing to biologics.

Answer 16

combine DMARDs

Question 17

If methotrexate doesn’t work or you can’t use methotrexate, then _____________ is the next DMARD you should use in RA.

Answer 17

leflunomide

Question 18

What is a common indication for hydroxychloroquine in RA?

Answer 18

Pregnancy!

Methotrexate and leflunomide are contraindicated in pregnancy.

Question 19

If you hear morning stiffness with back pain, you might be tempted to think the disorder is ankylosing spondylitis. However, there is one sign that will suggest RA: ______________.

Answer 19

C1 and C2 cervical neck pain

This indicates RA of the neck.