Rheumatoid Arthritis

Question 1

overview

Answer 1

chronic inflammation of the synovial lining of the joints, tendon sheaths and bursa

Question 2

synovial inflammation is called

Answer 2

synovitis

Question 3

RA is _x more common in __ than __

Answer 3

3
women
men

Question 4

genetic associations of RA

Answer 4

HLA DR4 (often present in RF positive)
HLA DR1 (occasionally present in RA patients)

Question 5

RF is an autoantibody present in around __ percent of RA patients

Answer 5

70

Question 6

RF targets the __ portion of the __antibody

Answer 6

Fc
IgG

Question 7

2 antibodies involved in RA

Answer 7

anti-CCP

Question 8

key symptoms RA

Answer 8

symmetrical distal polyarthropathy
pain
swelling
stiffness

Question 9

systemic symptoms of RA

Answer 9

fatigue
weight loss
flu like illness
muscle aches and weakness

Question 10

RA pain is ___ after rest and ___ with activity

Answer 10

worse
better

Question 11

palindromic rheumatism overview

Answer 11

self limiting short episodes of inflammatory arthritis
having positive RF or anti-CCP antibodies indicates it may develop to full RA

Question 12

common joints affected

Answer 12

Proximal interphalageal
metacarpophalangeal
metatarsophalangeal
wrist and ankle
cervical spine
knee, hips, shoulder

Question 13

joints almost never affected by RA

Answer 13

distal interphalangeal

Question 14

boutonnière deformity

Answer 14

bent up finger

Question 15

key signs in the hands

Answer 15

z shaped deformity
swan neck deformity
boutonnières deformity
ulnar deviation

Question 16

extra-articular manifestations

Answer 16

pulmonary fibrosis
bronchiolitis obliteratans
Felty’s syndrome
sjrogens
anaemia
CVD
eye manifestations
lymphadenopathy
carpel tunnel
amyloidosis

Question 17

eye manifestations

Answer 17

scleritis
episcleritis
keratitis
karatoconjuctivitis sicca
cataracts
retinopathy

Question 18

investigations

Answer 18

RF
if negative, anti-CCP
CRP, ESR
XRay

US can confirm synovitis

Question 19

referral guidelines

Answer 19

referral recommended for any adult with persistent synovitis, even if negative RF, antiCCP and inflammatory marker. urgent if involving the hands, feet, multiple joints or symptoms present >3 months

Question 20

differentials

Answer 20

SLE
fibromyalgia
infectious arthritis
osteoarthritis
gout
reactive arthritis
septic arthritis
sarcoidosis
seronegative spondyloarthritis

Question 21

arthralgia

Answer 21

joint stiffness

Question 22

arthritis

Answer 22

joint pain, tenderness and stiffness

Question 23

enthesitis

Answer 23

inflammation where tendons and ligaments join to bones
seen in psoriatic arthritis

Question 24

dactylitis

Answer 24

sausage fingers

Question 25

bursitis

Answer 25

inflammation of bursa

Question 26

myalgia

Answer 26

muscle pain

Question 27

myositis

Answer 27

weak, tired, painful muscles

Question 28

sclerodactyly

Answer 28

tightening and thickening of the skin of the fingers

Question 29

tophi

Answer 29

ston elike deposits of sodium rate in the synovial fluid, soft tissues or bones