Polyarticular Arthritis

Question 1

History

Answer 1

Sx acute vs chronic (>2 mos), inflammatory vs noninflammatory, type of joint involved (peripheral vs axial, native vs prosthetic, small vs large), symmetric vs asymmetric, episodic vs continuous vs migratory, # of joints involved; Mono- (1); oligo- (2-4); poly- (>4); presence of other systemic disease or symptoms (eg IBD)

Question 2

Workup

Answer 2

RF, CCP (for RA, below), ESR, CRP, Acute-onset (<6 weeks), consider parvovirus B19, HBV, HCV, Lyme serologies

Question 3

DDx

Answer 3

In addition to specific disease below: OA; gout/pseudogout; Lupus, PMR, paraneoplastic polyarthritis; sarcoidosis, (assoc w/hilar adenopathy, erythema nodosum); adult-onset Still disease (assoc w/high fevers, rash, increase ferritin); systemic vasculitides (eg granulomatosis with polyangiitis, churg-strauss syndrome); hemochromatosis (esp w/MCP and/or wrist involvement); PM and DM, fibromyalgia, reactive arthritis (Reiter syndrome), serum sickness

Question 4

Rheumatoid Arthritis

Definition

Answer 4

Symmetric, inflammatory arthritis affecting multiple peripheral joints

Question 5

Rheumatoid Arthritis

Extraarticular manifestations

Answer 5

Seen in 30-50% of pts; include sjogrens syndrome (dry eyes/mouth, most common), pulmonary (ILD), vasculitis, cardiac (pericarditis/CAD), cutaneous (rheumatoid nodules), anemia of chronic disease, decrease BMD, felty syndrome (RA + neutropenia + splenomegaly + recurrent infections)

Question 6

Rheumatoid Arthritis

Complications

Answer 6

Increase risk of infection, cervical subluxation -> pain, neuro deficit, instability

Question 7

Rheumatoid Arthritis

Epidemiology

Answer 7

).5-1% of caucasion adults; peak incidence 50-60 y

Question 8

Rheumatoid Arthritis

Pathophysiology

Answer 8

Loss of immune tolerance -> symmetric synovial inflammation, cartilage and bone destruction, joint deformity

Question 9

Rheumatoid Arthritis

Risk factors

Answer 9

Increase age, F>M, FHx; HLA-DRB1 loci; smoking

Question 10

Rheumatoid Arthritis

History

Answer 10

Typically polyarticular arthritis (common joints involved PIPs, MCPs, wrists, cervical spine); subacute onset of sc (healthy-> undifferentiated arthritis -> early RA -> RA); prolonged (>45min) AM stiffness; extra-articular manifestations; impact os sx on daily activities

Question 11

Rheumatoid Arthritis

Exam

Answer 11

Rheumatoid nodules (SC nodules commonly on pressure points), grip strength