RA + OA (+ septic)

Question 1

which joints are usually affected in RA

Answer 1

hands (PIPs + MCPs) and feet

Question 2

presentation RA

Answer 2

stiffness worse in mornings + better when warmed up, progresses to bigger joints

Question 3

what hand deformities can be seen in late RA

Answer 3

swan and boutonniere deformites

Question 4

what antibodies are tested for in RA

Answer 4

anti-CCP (most sensitive) + RF (first test)

Question 5

what imaging should be done in all patients with suspected RA

Answer 5

Xray hands and feet

Question 6

what imaging for synovitis can be done in RA

Answer 6

USS - good in early disease

Question 7

what can determine active disease in RA

Answer 7

DAS28 score + CRP

Question 8

what bloods may be seen in RA

Answer 8

raised CRP/ ESR and low Hb

Question 9

what genetics are assoc with RA

Answer 9

HLA DRB1

Question 10

what is the squeeze test in RA

Answer 10

squeeze MCPs –> pain

Question 11

what are poor prognostic factors for RA

Answer 11

anti-CCP // RF // X ray changes in 2 years // extra-articlar disease // male

Question 12

who normally gets RA

Answer 12

females 30-50

Question 13

early X ray findings RA

Answer 13

loss of joint space, soft tissue swelling, juxta-articular osteoporosis (thinning of bone)

Question 14

late Xray RA

Answer 14

periarticular erosion, subluxation

Question 15

extra-articular complications RA (6)

Answer 15

pulm fibrosis + effusions // keratoconjunctiviitis, scleritis // osteoporosis // CV risk // depression

Question 16

what is felty’s syndomre

Answer 16

RA + splenomegaly + low WCC

Question 17

initial mx RA

Answer 17

DMARD monotherapy + short course of pred

Question 18

what DMARDs are used in RA

Answer 18

1) methotrexare // sulfalazine, leflunomide, hydroxychloroquine

Question 19

what should always be given alongside methotrexate

Answer 19

5mg folic acid

Question 20

what monitoring needs to be done with methotrexare

Answer 20

FBC (mylosuprresion) + LFT’s (cirrhosis)

Question 21

when would biologics be given in RA

Answer 21

2 failed DMARDs

Question 22

what bioligcs can be given in RA (2)

Answer 22

anti-TNF (etanercept or infliximab)

Question 23

mechanism of OA vs RA

Answer 23

OA = wear and tear // RA = autoimmune

Question 24

which joints are usually affected in OA

Answer 24

large weight bearing joints (DID and PIP) // foot

Question 25

symmettry of joint pain OA vs RA

Answer 25

OA unilateral RA bilateral

Question 26

hand deformites OA

Answer 26

herbedens (DIP) and bouchard (PIP)

Question 27

knee symptoms OA

Answer 27

effusion, deformity, baker cyst

Question 28

complication OA in spine

Answer 28

osteophyte –> stenosis –> pain/ numbness

Question 29

Xray OA

Answer 29

LOSS (loss of joint space // osteophyte // subchondral sclerosis // subchondral cyst)

Question 30

presentation of pain and stiffness OA

Answer 30

worse on movement and relieved by rest

Question 31

lifestyle mx OA

Answer 31

strengthening and aorbic fitness, tai chi

Question 32

1st line mx OA pain

Answer 32

paracetamol and topical NSAIDs (knee or hands)

Question 33

2nd line pain mx OA (4)

Answer 33

oral NSAIDs / COX2i / opioids // intra-articular steroids

Question 34

what drug should be co-prescribed with NSAIDs or COX2

Answer 34

PPI

Question 35

pain modulator drugs in OA

Answer 35

Tricyclics eg amitriptyline // Anticonvulsants eg gabapentin

Question 36

last resort mx OA

Answer 36

surgery joint replacement

Question 37

SE enteracept

Answer 37

reactive TB (CXR first)