RHEUMATOID ARTHRITIS

Question 1

DEFINE

Answer 1

CHRONIC NON SUPPURATIVE INFLAMMATION OF SYNOVIAL JOINT CHARACTERISED BY TYPICAL FEATURES OF
- SYMMETRICAL POLYARTHRITIS AND TENOSYNOVITIS
-MORNING STIFFNES > 1HR
-ELEVATION OF ESR
-APPEARANCE OF AUTOANTIBODIES THAT TARGET IMMUNOGLOBINS

Question 2

AGE

Answer 2

25 TO 50 YEARS

Question 2

PATHOLOGY

Answer 2

-INITIALLY SYNOVIUM BECOMES EDEMATOUS FILLED WITH CELLULAR INFILTRATES
-INCREASE IN SYNOVIAL FLUID
-SYNOVIUM ULTIMATELY HYPERTROPHIES AND FORMATION OF PANNUS OCCURS
-DESTRUCTION OF JOINT AND TENDON
-ARTICULAR SYRFACE LOSES ITS SMOOTH AND SHINY APPEARANCE
-PANNUS EXTENDS INTO SUBCONDRAL BONE
-CARTILAGE DESTRUCTION
-BONE SURFACE LEFT RAW
-JOINT STARTS TO GET DEFORMED
-ADHESION DEVELOPS BETWEEN OPPOSING LAYERS OF PANNUS
-FIBROUS ANKYLOSIS
-THEN BONY ANKYLOSIS
-SIMILAR CHANGES IN TENDON CAUSING TENOSYNOVITIS
DEFORMITY

Question 2

SEX

Answer 2

FEMALE

Question 2

CLINICAL FEATURES

Answer 2

ACUTE SYMMETRICAL POLYARTHRITIS
FEVER
PNEUMONITIS
RHEUMATOID NODULE

Question 3

ACUTE SYMMETRICAL POLYARTHRITIS

Answer 3

PAIN
SWELLING
LOSS OF MOVEMENT OF AFFECTED FINGERS
MORNING STIFFNESS
PAIN AND STIFFNESS OF MULTIPLE JOINTS

Question 4

ON EXAMINATION

Answer 4

SWOLLEN BOGGY JOINTS
LATER STAGES, JOINT SUBLUXATED AND DISLOCATED
FEVER
RASH
SIGNS OF VASCULITIS

Question 5

DEFORMITIES IN RA

Answer 5

HAND=
BOUTONNIERE DEFORMITY - FLEXION OF PIP , HYPEREXTENSION OF DIP
SWAN NECK DEFORMITY - HYPEREXTENSION OF PIP AND FLEXION OF DIP
Z DEFORMITY
ELBOW=
FLEXION DEFORMITY
KNEE =
EARLY - FLEXION DEFORMITY
LATE - TRIPLE SUBLUXATION
ANKLE =
EQUINUS
FOOT =
HAMMER TOE , WIND SWEPT DEFORMITY

Question 6

INVESTIGATIONS

Answer 6

X RAY
BLOOD
SYNOVIAL FLUID EXAMINATION
SYNOVIAL BIOPSY

Question 7

X RAY

Answer 7

@ LESS
LOSS OF JOINT SPACE
EROSION OF ARTICULAR MARGINS
SUBCHONDRAL CYST
SOFT TISSUE SWELLING SHADOW
OSTEOPENIA

Question 8

BLOOD

Answer 8

ELEVATED ESR
LOW HB
RHEUMATOID FACTOR
ANTI CCP AB - ANTI CYCLIC CITRULLINATED PEPTIDE ANTIBODY

Question 9

DIAGNOSTIC CRITERIA BY ARA

Answer 9

MORNING STIFFNESS
ARTHRITIS OF 3 OR MORE AREAS
ARHRITIS OF HAND JOINTS
SYMMETRICAL ARTHRITIS
RHEUMATOID NODULES
SERUM RF
RADIOGRAPHC CHANGES

Question 10

TREATMENT

Answer 10

MEDICAL
ORTHOPAEDIC TT

Question 11

MEDICAL

Answer 11

NSAIDS
DMARDS
STEROIDS
BIOLOGICAL THERAPIES -
ANTI TNF ALPHA
ANTI B CELL THERAPY - RITUXIMAB
INHIBITOR OF T CELL ACTIVATION -ABATACEPT
ANTI IL6
ANTI IL1- ANAKINRA

Question 12

ORTHOPAEDIC TT

Answer 12

NON OPERATIVE -
PHYSIOTHERAPY
OCCUPATIONAL THERAPY
REHAB

OPERATIVE -
PREVENTIVE
PALLIATIVE - TENDON LENGTHENING
RECONSTRUCTIVE - TENDON TRANSFER