RA Flashcards
Which of the following is the most common joint involvement in rheumatoid arthritis (RA)?
A) First metatarsophalangeal joint
B) Knee
C) Wrist
D) Elbow
C) Wrist
Rationale: The most frequently involved joints in RA are the wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints. These joints are commonly affected in the early stages of RA, and joint involvement tends to be symmetric.
Which extra-articular manifestation of RA may present prior to the onset of arthritis in up to 40% of patients?
A) Pulmonary nodules
B) Subcutaneous nodules
C) Sjögren’s syndrome
D) Felty’s syndrome
B) Subcutaneous nodules
Rationale: Subcutaneous nodules are one of the most frequently observed extra-articular manifestations of RA, and they can develop even before the onset of arthritis in some patients. These nodules are typically associated with higher disease activity and the disease-related shared epitope.
Which of the following pulmonary manifestations is most commonly seen in patients with rheumatoid arthritis (RA)?
A) Pleural effusion
B) Interstitial lung disease (ILD)
C) Pulmonary embolism
D) Asthma
A) Pleural effusion
Rationale: Pleuritis and pleural effusion are the most common pulmonary manifestations of RA. Pleural effusions tend to be exudative with an increased number of monocytes and neutrophils. Interstitial lung disease (ILD) is also a common pulmonary complication but occurs less frequently than pleural effusions.
Which of the following is associated with a higher risk of lymphoma in patients with rheumatoid arthritis (RA)?
A) Low levels of disease activity
B) Use of methotrexate
C) Presence of Felty’s syndrome
D) Normal levels of C-reactive protein (CRP)
C) Presence of Felty’s syndrome
Rationale: RA patients with Felty’s syndrome (characterized by neutropenia, splenomegaly, and nodular RA) are at an increased risk of developing lymphoma, specifically diffuse large B-cell lymphoma. The risk of lymphoma also increases with high disease activity.
What is the most common hematologic abnormality in patients with rheumatoid arthritis (RA)?
A) Neutropenia
B) Thrombocytosis
C) Anemia
D) Leukocytosis
C) Anemia
Rationale: The most common hematologic abnormality in RA is normochromic, normocytic anemia, which correlates with the degree of inflammation, as reflected by serum markers such as CRP and ESR. Platelet counts may also be elevated as part of the acute-phase reaction in RA.
Which of the following is the most common valvular abnormality found in patients with rheumatoid arthritis (RA)?
A) Aortic regurgitation
B) Mitral regurgitation
C) Tricuspid stenosis
D) Pulmonary valve prolapse
B) Mitral regurgitation
Rationale: Mitral regurgitation is the most common valvular abnormality seen in patients with RA, occurring at a higher frequency than in the general population. This is part of the overall cardiovascular involvement in RA.
Which of the following is the most sensitive imaging technique for detecting early synovitis and bone marrow changes in rheumatoid arthritis (RA)?
A) Plain radiography
B) MRI
C) Ultrasound
D) CT scan
B) MRI
Rationale: MRI is the most sensitive imaging modality for detecting early synovitis, joint effusions, and bone marrow changes in RA. It is particularly useful in detecting early signs of inflammation that may not be visible on plain radiographs.
Which of the following DMARDs is considered the anchor drug for most combination therapies in the treatment of rheumatoid arthritis (RA)?
A) Hydroxychloroquine
B) Leflunomide
C) Methotrexate
D) Sulfasalazine
C) Methotrexate
Rationale: Methotrexate is considered the DMARD of choice and is the anchor drug for most combination therapies in RA. It has been shown to be effective in controlling disease activity and is typically administered weekly, either orally or subcutaneously.
Which flexor tendon is most commonly affected by rheumatoid arthritis (RA), potentially leading to tendon rupture?
A) Flexor digitorum profundus
B) Flexor pollicis longus
C) Flexor carpi radialis
D) Flexor digitorum superficialis
B) Flexor pollicis longus
Rationale: The flexor pollicis longus tendon is the most commonly affected flexor tendon in RA, and involvement can lead to tendon rupture. RA-related tenosynovitis often results in reduced grip strength and diminished range of motion, with “trigger” fingers being a frequent hallmark.
Which deformity is characterized by flexion of the PIP joint with hyperextension of the DIP joint in rheumatoid arthritis (RA)?
A) Swan-neck deformity
B) Z-line deformity
C) Boutonnière deformity
D) Ulnar deviation
C) Boutonnière deformity
Rationale: Boutonnière deformity occurs when the PIP joint is flexed while the DIP joint is hyperextended. This deformity is associated with the destruction of tendons and soft tissues in the hands due to RA.
Which of the following deformities is seen in rheumatoid arthritis (RA) when the first MCP joint is subluxed with hyperextension of the first IP joint?
A) Swan-neck deformity
B) Z-line deformity
C) Boutonnière deformity
D) Ulnar deviation
B) Z-line deformity
Rationale: The Z-line deformity occurs when there is subluxation of the first MCP joint with hyperextension of the first interphalangeal (IP) joint. This deformity is commonly seen in RA as a result of joint destruction.
Which of the following factors increases the likelihood of developing extraarticular manifestations in rheumatoid arthritis (RA)?
A) Obesity
B) Regular physical exercise
C) History of cigarette smoking
D) Advanced age
C) History of cigarette smoking
Rationale: Cigarette smoking is a significant risk factor for the development of extraarticular manifestations in RA. Patients with a history of smoking are more likely to develop complications such as subcutaneous nodules, secondary Sjögren’s syndrome, and interstitial lung disease (ILD).
Secondary Sjögren’s syndrome in RA is defined by the presence of which of the following?
A) Rheumatoid factor only
B) Keratoconjunctivitis sicca (dry eyes) or xerostomia (dry mouth)
C) Pulmonary nodules
D) Hepatomegaly
B) Keratoconjunctivitis sicca (dry eyes) or xerostomia (dry mouth)
Rationale: Secondary Sjögren’s syndrome occurs when keratoconjunctivitis sicca (dry eyes) or xerostomia (dry mouth) is present in association with another connective tissue disease such as RA. It is one of the common extraarticular manifestations of RA.
Which extraarticular manifestation of rheumatoid arthritis (RA) is characterized by lung involvement and is often diagnosed by high-resolution chest CT scan showing infiltrative opacification or ground-glass opacities?
A) Pulmonary fibrosis
B) Pulmonary nodules
C) Interstitial lung disease (ILD)
D) Asthma
C) Interstitial lung disease (ILD)
Rationale: Interstitial lung disease (ILD) is a common extraarticular manifestation of RA. It is characterized by symptoms like dry cough and progressive shortness of breath, and is diagnosed using high-resolution chest CT, which shows ground-glass opacities and infiltrative changes in the periphery of the lungs.
Which extraarticular manifestation is characterized by splenomegaly, neutropenia, and nodular rheumatoid arthritis?
A) Pulmonary fibrosis
B) Felty’s syndrome
C) Secondary Sjögren’s syndrome
D) Vasculitis
B) Felty’s syndrome
Rationale: Felty’s syndrome is characterized by the clinical triad of neutropenia, splenomegaly, and nodular rheumatoid arthritis. It is a serious complication of long-standing, severe RA and can lead to increased risk of infection due to neutropenia.
Which of the following is the most common pulmonary manifestation of rheumatoid arthritis (RA)?
A) Pleuritis
B) Pulmonary hypertension
C) Pulmonary embolism
D) Acute respiratory distress syndrome (ARDS)
A) Pleuritis
Rationale: Pleuritis is the most common pulmonary manifestation of RA, and it may present with pleuritic chest pain, dyspnea, pleural friction rub, and pleural effusion. Exudative pleural effusions with increased monocytes and neutrophils are often found in these cases.
Which radiographic finding is characteristic of usual interstitial pneumonia (UIP) in patients with rheumatoid arthritis (RA)?
A) Bilateral ground-glass opacities
B) Honeycomb changes in the periphery and lower lungs
C) Multiple nodules throughout both lungs
D) Pleural effusions with thickening
B) Honeycomb changes in the periphery and lower lungs
Rationale: UIP is characterized by progressive scarring of the lungs, which appears on chest CT as honeycomb changes, typically seen in the periphery and lower portions of the lungs. This pattern is distinct and is associated with a poor prognosis.
Which of the following pulmonary manifestations in RA may be associated with cigarette smoking?
A) Pleuritis
B) Pulmonary nodules
C) Interstitial lung disease (ILD)
D) Pulmonary hypertension
C) Interstitial lung disease (ILD)
Rationale: ILD is associated with cigarette smoking, and it is more common in patients with higher disease activity in RA. ILD can present with dry cough, shortness of breath, and is diagnosed through high-resolution chest CT scans showing ground-glass opacities and infiltrative changes
Which of the following is a rare subset of pulmonary nodulosis in RA that is associated with silica exposure?
A) Rheumatoid pneumonia
B) Caplan’s syndrome
C) Pneumoconiosis
D) Respiratory bronchiolitis
B) Caplan’s syndrome
Rationale: Caplan’s syndrome is a rare subset of pulmonary nodulosis in RA, characterized by the development of lung nodules and pneumoconiosis following silica exposure. It can be seen in individuals who have had occupational exposure to silica dust.
What is the most frequent site of cardiac involvement in rheumatoid arthritis (RA)?
A) Left ventricle
B) Pericardium
C) Aorta
D) Right atrium
B) Pericardium
Rationale: The pericardium is the most frequent site of cardiac involvement in RA. Although clinical manifestations of pericarditis occur in less than 10% of patients, pericardial involvement is detectable in nearly half of RA patients via echocardiogram or autopsy studies.
Which of the following is the most common valvular abnormality seen in patients with rheumatoid arthritis (RA)?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Pulmonary valve insufficiency
B) Mitral regurgitation
Rationale: Mitral regurgitation is the most common valvular abnormality in RA, occurring at a higher frequency than in the general population, potentially contributing to heart-related complications.
Which of the following factors is most commonly associated with the development of rheumatoid vasculitis?
A) Early disease onset
B) Long-standing disease with positive serum RF or anti-CCP antibodies
C) Recent onset of rheumatoid arthritis
D) Absence of hypocomplementemia
B) Long-standing disease with positive serum RF or anti-CCP antibodies
Rationale: Rheumatoid vasculitis typically occurs in patients with long-standing rheumatoid arthritis, who also test positive for serum rheumatoid factor (RF) or anti–cyclic citrullinated peptide (CCP) antibodies, and exhibit hypocomplementemia.
What is the typical incidence of rheumatoid vasculitis in patients with rheumatoid arthritis?
A) 5%
B) 10%
C) <1%
D) 2-3%
C) <1%
Rationale: The incidence of rheumatoid vasculitis has significantly decreased in the past decade and is now present in less than 1% of patients with rheumatoid arthritis.
Which of the following cutaneous signs is commonly associated with rheumatoid vasculitis?
A) Erythema nodosum
B) Petechiae and purpura
C) Lichen planus
D) Skin plaques
B) Petechiae and purpura
Rationale: Common cutaneous signs of rheumatoid vasculitis include petechiae, purpura, digital infarcts, gangrene, and livedo reticularis. In severe cases, large, painful lower extremity ulcerations may develop.
What type of neuropathy is commonly seen in patients with rheumatoid vasculitis?
A) Guillain-Barré syndrome
B) Mononeuritis multiplex
C) Multiple sclerosis
D) Diabetic neuropathy
B) Mononeuritis multiplex
Rationale: Sensorimotor polyneuropathies, such as mononeuritis multiplex, are associated with rheumatoid vasculitis and often present with symptoms like numbness, tingling, or focal muscle weakness.
Which of the following is the most common hematologic abnormality in patients with rheumatoid arthritis?
A) Iron deficiency anemia
B) Normochromic, normocytic anemia
C) Megaloblastic anemia
D) Hemolytic anemia
B) Normochromic, normocytic anemia
Rationale: Normochromic, normocytic anemia is the most common hematologic abnormality in rheumatoid arthritis and often correlates with the degree of inflammation as indicated by serum CRP and ESR levels.
Which of the following is true regarding platelet counts in patients with RA?
A) Platelet counts are generally low in RA patients.
B) Platelet counts may be elevated as an acute-phase reactant.
C) Platelet counts are rarely elevated, even during flares.
D) Platelet counts are usually elevated in Felty’s syndrome but not in RA.
B) Platelet counts may be elevated as an acute-phase reactant.
Rationale: Elevated platelet counts are often seen in RA as part of the acute-phase response to inflammation.
Felty’s syndrome in RA is defined by which of the following clinical features?
A) Anemia, splenomegaly, and elevated ESR
B) Neutropenia, splenomegaly, and nodular RA
C) Thrombocytosis, lymphadenopathy, and elevated CRP
D) Lymphadenopathy, jaundice, and anemia
B) Neutropenia, splenomegaly, and nodular RA
Rationale: Felty’s syndrome is characterized by the triad of neutropenia, splenomegaly, and nodular rheumatoid arthritis and is seen in less than 1% of RA patients.
T-cell large granular lymphocyte leukemia (T-LGL) in RA is characterized by:
A) Acute onset with fever and chills
B) Chronic, indolent clonal growth of LGL cells leading to neutropenia and splenomegaly
C) Rapid development of lymphadenopathy and skin rashes
D) Only developing in later stages of RA, like Felty’s syndrome
B) Chronic, indolent clonal growth of LGL cells leading to neutropenia and splenomegaly
Rationale: T-LGL leukemia is characterized by chronic, indolent clonal growth of large granular lymphocytes, leading to neutropenia and splenomegaly, and it can occur early in the course of RA.
Which of the following is true about leukopenia in RA?
A) Leukopenia is common and usually unrelated to medication use.
B) Leukopenia is most often seen as a side effect of drug therapy.
C) Leukopenia is a hallmark of Felty’s syndrome but not related to drug therapy.
D) Leukopenia is a primary symptom of RA and not related to treatment.
B) Leukopenia is most often seen as a side effect of drug therapy.
Rationale: Leukopenia in RA is uncommon except as a side effect of drug therapy, particularly with disease-modifying antirheumatic drugs (DMARDs).
What is the diagnostic specificity of anti-cyclic citrullinated peptide (anti-CCP) antibodies for rheumatoid arthritis (RA)?
A) Low sensitivity and low specificity
B) High sensitivity and low specificity
C) High specificity and low sensitivity
D) High sensitivity and high specificity
C) High specificity and low sensitivity
Rationale: Anti-CCP antibodies have high specificity for RA (around 95%), making them useful for distinguishing RA from other forms of arthritis, although they may not be present in all RA patients.
Which of the following is true regarding the presence of serum rheumatoid factor (RF) in RA?
A) It is always present in patients with RA.
B) It is specific to RA and not found in any other conditions.
C) It can be found in other chronic inflammatory diseases, as well as in healthy individuals.
D) It is only found in advanced cases of RA.
C) It can be found in other chronic inflammatory diseases, as well as in healthy individuals.
Rationale: Serum RF is not specific to RA and can also be found in other conditions, such as primary Sjögren’s syndrome, systemic lupus erythematosus, chronic infections, and even in a small percentage of healthy individuals.
What is the most frequently measured isotype of rheumatoid factor (RF) in patients with RA?
A) IgA
B) IgM
C) IgG
D) IgE
B) IgM
Rationale: The IgM isotype of RF is the most commonly measured by commercial laboratories, and it is found in the majority of patients with RA.
Which of the following antibodies is most associated with worse outcomes in rheumatoid arthritis?
A) Rheumatoid factor (RF)
B) Antinuclear antibodies (ANA)
C) Anti-cyclic citrullinated peptide (anti-CCP) antibodies
D) Anti-MPO antibodies
C) Anti-cyclic citrullinated peptide (anti-CCP) antibodies
Rationale: The presence of anti-CCP antibodies is a strong predictor of worse outcomes in RA, as it is associated with more severe disease progression.
What is typically the first radiographic finding in rheumatoid arthritis (RA)?
A) Joint subluxation
B) Periarticular osteopenia
C) Subchondral erosions
D) Soft tissue swelling
B) Periarticular osteopenia
Rationale: The initial radiographic finding in RA is typically periarticular osteopenia, although it is often difficult to appreciate on plain radiographs.
What is commonly seen on advanced radiographic images of rheumatoid arthritis (RA)?
A) Periarticular osteopenia
B) Soft tissue swelling
C) Joint subluxation and collapse
D) Synovial fluid accumulation
C) Joint subluxation and collapse
Rationale: In advanced RA, radiographs may reveal signs of severe destruction, including joint subluxation and collapse, often due to progressive joint damage.
Which of the following conventional DMARDs is considered the DMARD of choice for the treatment of rheumatoid arthritis (RA)?
A) Hydroxychloroquine
B) Sulfasalazine
C) Methotrexate
D) Leflunomide
C) Methotrexate
Rationale: Methotrexate is the DMARD of choice for RA and is the anchor drug for most combination therapies due to its proven efficacy and safety.
What is the primary mechanism of action for methotrexate in the treatment of rheumatoid arthritis (RA)?
A) Inhibition of pyrimidine synthesis
B) Stimulation of adenosine release from cells
C) Inhibition of cyclooxygenase enzymes
D) Depletion of synovial fluid
B) Stimulation of adenosine release from cells
Rationale: Methotrexate stimulates adenosine release from cells, producing an anti-inflammatory effect, which is key to its action in RA.
Which DMARD is not considered a true DMARD due to its lack of effect on radiographic progression of disease?
A) Hydroxychloroquine
B) Sulfasalazine
C) Leflunomide
D) Methotrexate
Correct Answer:
A) Hydroxychloroquine
Rationale: Hydroxychloroquine is not considered a true DMARD as it does not delay radiographic progression of RA, though it can be used for early, mild disease or as adjunctive therapy.
What co-therapy is commonly prescribed alongside methotrexate to mitigate side effects? A) Prednisone
B) Folic acid
C) Hydroxychloroquine
D) Leflunomide
B) Folic acid
Rationale: Folic acid is prescribed alongside methotrexate to help mitigate some of the drug’s side effects, particularly those related to folate deficiency.
Which of the following DMARDs is safest to use during pregnancy for the treatment of rheumatoid arthritis (RA)?
A) Methotrexate
B) Leflunomide
C) Hydroxychloroquine
D) Biologic agents
C) Hydroxychloroquine
Rationale: Hydroxychloroquine is considered one of the safest DMARDs during pregnancy, while methotrexate and leflunomide are contraindicated due to their teratogenic effects.
