RA

Question 1

PATHOGENESIS

Answer 1

TH1/TH17 mediated process thus pro-inflammatory; + RANKL leads to “bone erosion” and anti-RF and anti-CCP Ab leads to “activation of complement cascade” leads to skin findings

Question 2

ACR criteria

Answer 2

point system; > 6 points based on joint involvement (PIP and MCP only), serology, acute phase reactants (CRP, ESR), duration of sx, and skin findings

Question 3

What is the difference? Rheumatoid nodules vs. Rheum nodulosis vs. therapy induced rheumatoid nodulosis

Answer 3

rheum nodules - asymptomatic nodules over bony prominences

rheum nodulosis- ulcerative nodules WITHOUT active joint disease

therapy induced rheum nodulosis - PAINFUL nodules following initiation of MTX or TNF alpha

Question 4

what is the treatment for rheum nodules?

Answer 4

ILK vs. excision (recurrence is common)

Question 5

tx of RA

Answer 5

Short term –> oral prednisone
Long term –> DMARDS (MTX, plaquenil, TNF alpha inhibitors, sulfasalazine, leflunomide, abatecept, rituximab, and tocilizumab)

Question 6

what is felty syndrome?

Answer 6

subtype of RA; RA + neutropenia + splenomegaly + refractory leg ulcers; Tx: G-CSF and/or splenectomy