RHEUM

Question 1

Joints affected in rheum arthritis in hands?

Answer 1

SYMMETRICAL:
MCP
PIP (BOUTOUNIERE)
MTP
Swan necking of DIP
Z THUMB

Question 2

Bloods for RA?

Answer 2

Serum Rheumatoid Factor (RhF) is positive in 70% of cases (SENSITIVE)

Anti-CCP are highly specific for RA; suggests erosive disease and joint damage to occur (40%)

Inflammatory markers- ↑ESR and ↑CRP

FBC- Looks for anaemia of chronic disease, thrombocytosis secondary to inflammation/leucopenia or felty’s syndrome.

Question 3

RA on X-RAY?

Answer 3

Loss of joint space
Osteopenia (periarticular)
Subluxation
Soft tissue swelling
Erosions (periarticular)
Synovitis (inflamed seen on CT/MRI)

Question 4

RA Mx?

Answer 4

Conservative: Lifestyle +Physio

Medical: Pain relief via paracetamol, Ibuprofen
DMARDS- Methotrexate
+ Bridging prednisolone

2nd line: TNF Inhibitors

Question 5

way to monitor disease activity?

Answer 5

DAS28 (Disease activity score)

Question 6

RA Differentials?

Answer 6

Psoriatic Arthririts
Reactive arthritis
SLE
Osteoarthritis

Question 7

Examinations to do for suspected RA?

Answer 7

MSK of above and below, upper neuro exam

Question 8

Blood tests for SLE?

Answer 8

CRP/ESR
99% are ANA positive
rheumatoid factor positive
Anti-dsdna
Anti-Smith
anti-Ro
anti-La

Question 9

Management of SLE?

Answer 9

Conservative:
- Avoid sun exposure
- smoking cessation

Medical:
- DMARDS: Hydroxychloroquine
- Analgesia
- Corticosteroids
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