Rheumatoid arthritis

Question 1

Briefly describe the pathophysiology of rheumatoid arthritis

Answer 1

Autoimmune inflammation and destruction of the synovium (inflammatory arthritis)

Question 2

Describe the typical symptoms of rheumatoid arthritis

Answer 2

Joint pain and stiffness which lasts for > 1 hour in the morning and tends to improve with activity

Question 3

Which autoantibodies may be present in a patient with rheumatoid arthritis?

Answer 3

• Rheumatoid factor (RF) antibodies

- Anti-citrullinated cyclic peptide (anti-CCP) antibodies

Question 4

What is the mnemonic to remember the typical XR findings in rheumatoid arthritis?

Answer 4

LESS:
L - loss of joint space
E - erosion
S - soft tissue swelling 
S - soft bones (osteopenia)

Question 5

Describe the medical management of rheumatoid arthritis

Answer 5

• Ibuprofen/NSAIDs
• Prednisolone
• Methotrexate (DMARD)
• Biologics, e.g. adalimumab

Question 6

Give three examples of complications of rheumatoid arthritis?

Answer 6

• Atlantoaxial subluxation (leading to spinal cord compression)
• Pulmonary fibrosis
• Eye disorders e.g. scleritis

Question 7

Which diseases must be screened for before starting a patient on an anti-TNF biologic drug such as adalimumab or infliximab?

Answer 7

TB and hepatitis B

Question 8

Which signs may be present in the hands in a patient with rheumatoid arthritis?

Answer 8

• Z thumb
• Ulnar deviation
• Swan neck deformity (hyperextended PIP with flexed DIP)
• Boutonnieres deformity (hyperextended DIP with flexed PIP)