Rheum - Polyarticular Arthritis

Question 0

A patient with joint pain has soft tissue swelling and tenderness with normal passive range of motion?

Answer 0

Extra-articular soft tissue inflammation – bursitis or tendinitis

Question 1

Causes of joint pain without inflammatory changes?

Answer 1

1. Osteoarthritis
2. Fibromyalgia
3. Hypothyroidism
4. Neuropathic pain

Question 2

If polyarticular disease with acute Sx?

If acute and symmetric?

Answer 2

It’s less than six weeks consider: Viral infection(hepatitis B/C, Rubella, parvovirus)

If causing symmetric polyarthritis and fever consider: rheumatic fever

Question 3

Symmetric peripheral polyarthritis characteristic finding of?

Answer 3

Rheumatoid arthritis or lupus

Question 4

Psoriatic arthritis – findings?

Answer 4

1. Usually peripheral joint involvement with 5+ joints
2. Need skin rash/nail changes
3. Sausage digits (caused by inflammation at periosteum, tendons, insertion points)

Question 5

Reactive arthritis symptoms? Caused by what organisms?

Answer 5

Can’t see, can’t Pee, can’t climb a tree

GI and GU: Salmonella, Shigella, Campylobacter, Yersinia, or Chlamydia

Question 6

Hand finding in Osteoarthritis vs RA?

Answer 6

Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)

Swan neck deformity, boutonnière deformity, ulnar deviation

Question 7

Rheumatoid nodules found where?

Answer 7

Extensor surfaces of proximal ulnar, lungs

Question 8

Rheumatoid factor?

Answer 8

IgM that reacts to Fc portion of IgG

Question 9

Radiologic findings in rheumatoid arthritis?

Answer 9

1. Erosion of periarticular bone and cartilage
2. Loss of joint space
3. Joint space narrowing

Question 10

Felty syndrome?

Answer 10

#Rheumatic arthritis
#splenomegaly
#neutropenia

Can also see lymphadenopathy, thrombocytopenia, leukopenia

Question 11

Classic Disease modifying antirheumatic drugs? Drug of choice?

Answer 11

DoC: Methotrexate

hydroxychloroquine, sulfasalazine, gold, penicillamine

Question 12

Biologic agents? Advantage over other DMARDS? Side effect?

Answer 12

TNF antagonists (etanercept, infliximab, adalimumab) reduce disease activity within weeks as opposed to months.

Reactivation TB

Question 13

Drugs for patients who have failed Biologics and DMARDS?

Answer 13

Immunosuppressive agents – azathioprine, cyclosporine, cyclophosphamide, leflunomide

Question 14

low-dose corticosteroids may have this effect on rheumatic arthritis?

Answer 14

Slow progression of bone erosions

Question 15

Extra-articular findings in rheumatoid arthritis?

Answer 15

#Eyes – episcleritis, Keratoconjunctivitis sicca (Sjogren's)
#heart - pericarditis 
#Lungs – pleural effusions and nodules
#spine - cervical subluxation, compression
#vasculitis  – skin ulcers, bowel, nerves
#Baker cyst 
#Anemia

Question 15

Sicca syndrome?

Answer 15

#RA
#Dry eyes and mouth

Question 16

Specific RA tests?

Answer 16

Anti-CCP > RF

Question 17

RA Scoring?

Answer 17

#joint involvement (Up to five points)
#Elevated ESR or CRP
#Duration longer than six weeks
#RF or anti-CCP

6+ points = RA

Question 18

Caplan syndrome?

Answer 18

#RA
#Pneumoconiosis
#Lung nodules

Question 19

Most common cause of death in RA?

Answer 19

Coronary artery Disease

Question 20

Patient with RA and erosive disease on x-ray needs at least?

Answer 20

Methotrexate to slow disease progression

Question 21

RA pt undergoing surgery should get?

Answer 21

Cervical spine x-ray to rule out subluxation before intubation

Question 22

Adverse effects of methotrexate?

Answer 22

#Liver toxicity
 #bone marrow suppression
#pulmonary toxicity

Question 23

Before you can give a patient a TNF inhibitor, need?

Answer 23

PPD

Question 24

Patient with RA recently started on medication presents with eye problems – possible cause? Test?

Answer 24

Hydroxychloroquine can cause retinal toxicity

Dilated eye exam

Question 25

Patient with RA recently started on medication presents with rash and hemolysis – drug?

Answer 25

Sulfasalazine

Question 26

Patient with RA recently started on medication presents with nephrosis - drug?

Answer 26

Gold salts

Question 27

Features of JRA OR Adult Still disease?

Answer 27

#Fever spikes
#Salmon colored rash on chest

Also:
#Splenomegaly
#Pericardial diffusion
#Mild joint symptoms

Question 28

Treatment Of JRA/stills?

Answer 28

#Aspirin/NSAIDs
#if no response, steroids
#If steroid resistant, TNF drugs