Rheumatoid Arthritis

Question 1

Radiographic changes of the hand, including erosions and
decalcification.

Answer 1

T

Question 2

v upper extremity complaints are a hallmark of the RA disease

Answer 2

T

Question 3

disease severity is commonly linked to the age of onset

Answer 3

T

Question 4

A family history of RA increases the
lifetime risk from three-fold to five-fold

Answer 4

T

Question 5

symmetric
hand pain lasting 6 weeks or longer without a known etiology should
prompt consideration of inflammatory arthropathy

Answer 5

T

Question 6

Rheumatoid nodules are present
only in a minority of RA patients

Answer 6

T

Question 7

Nodules present only in the hand

Answer 7

F Nodules are commonly located on
extensor pads associated with synovitis but can appear in multiple
extra-articular tissues including eyes, lungs, or vocal cords

Question 8

Any synovial joint may be
affected, but hand involvement is often seen as a hallmark of disease

Answer 8

T

Question 9

First joint that effected with RA ?why?

Answer 9

The metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and wrist are often affected first due to the relatively high synovial surface area.

Question 10

Secondarily, large
joints such as the elbows, knees, hips, shoulders are affected

Answer 10

T

Question 11

Even small articular surfaces, such as the ossicles of the middle ear, can be involved

Answer 11

T

Question 12

patients may present with synovitic rheumatoid nodules around large
joints. Rheumatoid nodules may be unsightly, painful, irritating to
adjacent tendons, or cause nerve compression.

Answer 12

T

Question 13

the distal interphalangeal joint (DIP) joint
is often spared in RA

Answer 13

T

Question 14

early wrist erosions appear at the scaphoid waist, ulnar
styloid, and the distal radioulnar joint (DRUJ)

Answer 14

T

Question 15

In RA, synovitis
typically affects the radiocarpal joint more than the midcarpal
joint

Answer 15

T

Question 16

ynovitis around the wrist joint often involves the extensor compartments and may grow around the tendons

Answer 16

T

Question 17

vaughan-jackson syndrome

Answer 17

process is
compounded by dorsal prominence of caput ulnae leading to progressive tendon ruptures from ulnar to radial along the dorsal wrist

Question 18

Tendon ruptures are often sudden and are usually painless

Answer 18

T though
synovitis may be painful at the site before the rupture

Question 19

Osteophytes
on the radius or carpus can also lead to tendon attrition

Answer 19

T

Question 20

Mannerfelt
lesion

Answer 20

scaphoid osteophytes or synovitis can lead to attrition of the
flexor pollicis longus (FPL) tendon,

Question 21

Tendon reconstraction achieved through tendon transfers

Answer 21

T

Question 22

once a musculotendinous unit has ruptured, that muscle is no longer useful in the setting of RA.

Answer 22

T

Question 23

patients often complain about the inability to fully extend their
fingers what are the causes ?

Answer 23

• ulnar subluxation of the extensor tendon due to attenuation of the radial sagittal band
• progressive subluxation and volar translation of the proximal phalanx on the metacarpal head
• ## Very rarely, loss of extension can be due to compression on the posterior interosseous nerve

Question 24

Passively correctable ulnar translation of the joint or tendons can be corrected with soft-tissue surgeries
such as extensor tendon centralization (typically a synovectomy and
radial sagittal band imbrication) or a cross-intrinsic tendon transfer
to apply more dynamic radial force

Answer 24

T

Question 25

if the digit is shortened, irreducible, or the articular erosions are severe

Answer 25

first-line management is often joint replacements with silicone metacarpophalangeal arthroplasty

Question 26

PIP joint, wrist, and elbow are treated with joint replacement in only select cases

Answer 26

T

Question 27

swan neck and boutonniere deformities can occur in the same hand in different digits

Answer 27

T

Question 28

swan neck less common than boutonniere deformities

Answer 28

F swan-neck is more common than boutonniere

Question 29

In swan-neck, the anatomic derangement occur in the PIP

Answer 29

In swan-neck, the anatomic derangement can occur at any of the three joints of the finger (MCP, PIP, or DIP joints)

Question 30

Treatment depends on the severity of the deformity and whether the PIP joints are actively and passively reducible

Answer 30

T

Question 31

Treatment depends on the severity of the deformity and whether the PIP joints are actively and passively reducible

Answer 31

T

Question 32

In contrast to swan-neck, the boutonniere deformity is caused by pathology intrinsic to the PIP joint.

Answer 32

T

Question 33

Thumb deformities in RA

Answer 33

Type I: Boutonniere deformity (most common) Type II: Boutonniere deformity with carpometacarpal (CMC) joint dislocation or subluxation Type III: Swan-neck deformity with metacarpal adduction Type IV: Gamekeeper's deformity (attenuation of MCP ulna collateral ligament) Type V: Swan-neck deformity without metacarpal adduction deformity

Question 34

Management for thumb anomalies is largely dependent on stabilization of the metacarpophalangeal (MP) joint and tendon reconstructions

Answer 34

T

Question 35

arthrodesis of the MCP joint is the best solution to establish stability of the MCP joint.

Answer 35

T

Question 36

arthrodesis of the MCP joint is the best solution to establish stability of the MCP joint.

Answer 36

T

Question 37

CMC arthroplasty can be considered if the CMC joint is painful,

Answer 37

T

Question 38

PIP joint IN RA

Answer 38

Attenuation of volar plate Attenuation of transverse retinacular ligament Dorsal translation of conjoint lateral band Flexor tenosynovitis Rupture of flexor digitorum superficialis

Question 39

MCP change

Answer 39

Attenuation of volar plate Flexor tenosynovitis Intrinsic tendon adhesion Intrinsic muscle contracture Rupture of extensor insertion onto base of proximal phalanx

Question 40

SLE-related arthritis may present with similar findings as RA

Answer 40

T

Question 41

SLE deformity is more likely to be the result of soft-tissue attenuation and laxity with sparing of the MCP joints

Answer 41

T

Question 42

Most patients complain of pain with activities, but also note limited motion, dissatisfaction with appearance, and pain at rest

Answer 42

T

Question 43

JIA also appears to occur less frequently in African American and Asian populations compared to Caucasians

Answer 43

T

Question 44

Psoriatic hand deformity can include nail deformities in about 80% of patients

Answer 44

T

Question 45

(15%) in patients with psoriatic arthritis variants hjave nail deformities

Answer 45

T

Question 46

30% of patients with psoriasis develop Psoriatic arthritis

Answer 46

T

Question 47

Psoriatic arthritis associated with obesity, positive family history, and HLA-B27 positivity

Answer 47

T

Question 48

Psoriatic arthritis of the hands typically affects the DIP joint, in contrast to RA where the DIP joint is typically spared

Answer 48

T

Question 49

A severe form of inflammatory arthropathy of the hands, known as arthritis mutilans

Answer 49

T

Question 50

Arthritis mutilans causes acroosteolysis of the phalanges, pencil in cup joint changes, and telescoping (opera-glass hands) of the digits

Answer 50

T

Question 51

arthrodesis is the only surgical option that may maintain digit length and reduce pain

Answer 51

T

Question 52

Multiple systems may be affected in SLE, but joints and skin are involved in up to 90% of patients with the disease.

Answer 52

T

Question 53

In contrast to RA, erosive arthritis and loss of articular surfaces are not typical not typical with SLE

Answer 53

T

Question 54

Jaccoud arthropathy

Answer 54

erosive arthritis and loss of articular surfaces are not typical. This clinical constellation results in a classicJaccoud arthropathy where the deformity is the result of soft-tissue laxity and ligamentous shortening rather than from direct destruction of the joints

Question 55

Surgery for hand deformity in SLE is similar to RA, but there is less need for arthroplasty and arthrodesis

Answer 55

T

Question 56

Surgical interventions for a plastic surgeon may include lipotransfer in scleroderma

Answer 56

T

Question 57

Dactylitis with fusiform swelling of a single digit (sausage digit) is a hallmark finding.for Reiter Syndrome

Answer 57

T

Question 58

The glabrous skin on the plantar feet and palms of the hands may develop keratoderma blennorrhagicum which is pathognomonic for reactive arthritis

Answer 58

T

Question 59

Treatment is largely medical and can be similar to other inflammatory arthropathies

Answer 59

T