Rheumatoid Arthritis

Question 1

Diagnostic criteria for rheumatoid arthritis

Answer 1

Question 2

Typical findings of synoival fluid taken a patient with rheumatoid arthritis

Answer 2

WCC 2000-> 10,000, PMN >50%

Question 3

Notes on Felty’s syndrome

Answer 3

Clinical triad -> RA, neutropaenia, splenomegaly

Question 4

Factors associated with poor prognosis in rheumatoid arthritis

Answer 4

Smoking
RF and anti-CCP titre
HL-DRB1*04 homozygosity
*High CRP
Radiographic erosions at baseline (strongest marker of poor prognosis)
Swollen joint count
High disability HAQ score
Rheumatoid nodules

Question 5

Typical radiographic features of rheumatoid arthritis

Answer 5

Symmetric involvement
Periarticular soft-tissue swelling
Juxta-articular osteoporosis
Marginal erosions
Joint space narrowing

Question 6

Notes on cardiovascular complications of rheumatoid arthritis

Answer 6

Most common complication is ischaemic heart disease -> RA associated with accelerated rate of atherosclerosis
Fourfold increase in rate of incident cardiovascular event
Risk reduced in responders of biological DMARDs
High CRP at baseline predictive of subsequent death from cardiovascular disease

Question 7

Genes associated with risk of rheumatoid arthritis

Answer 7

DR4
STAT4
PADI
PTPN22

Question 8

Notes on anti-CCP

Answer 8

Highly specific for rheumatoid arthritis
Highly predictive of rheumatoid arthritis in asymptomatic patient
Marker of severe erosive disease
Not useful to assess current RA activity

Question 9

Markers that indicate activity of Rheumatoid arthritis

Answer 9

CRP
ESR
Swollen joint count

Question 10

Ocular manifestations of rheumatoid arthritis

Answer 10

Keratoconjunctivits sicca (most common) - dry burning, gritty eyes caused by decreased tear production
Episcleritis
Scleritis
Corneal ulceration
Keratitis
Iatrogenic -> steroid induced cataracts, chloroquine retinopathy

Question 11

Management of palindromic rheumatism

Answer 11

Hydroxychloroquine