Rheumatoid Arthritis Flashcards
True for the laboratory fratures of RA
A. Serum Igg rf has been found in 75-80%
B. The presence of serum anti ccp AB has the same sensitivity as serum RF
C. Synovial fluid WBC usually id <2000
D. Periarticular osteopenia is a classic late finding on plain radiograph
Answer: B
A. Should be IgM RF
C. This level is found on osteoarthritis.. in RA level is usually 5,000 to 50,000
D. This id an early finding
Which of the ff statement is correct with regards to the management of rheumatoid arthritis?
A. Nsaids are considered as the core of treatment at present
B. Methotrexate is the DMARD of choice as to its treatment
C. Most cases respond to monotherapy using methotrexate
D. Low dose glucocorticoids for severe extraarticulat RA
Answer: B
A. Formerly the core but now treated as adjunctive therapy
C. Usually needs multiple drugs
D. High dose dapat
The following are extraarticular manifestations of RA except
A. Thrombocytopenia
B. Pleuritis
C. Vasculitis
D. Pericarditis
Answer: A
Usually will present with thrombocytosis
Immune mediated thrombocytopenia is rare
A 30 yr old pregnant female on 20 weeks AOG came in due to joint pains diagnosed with RA. Which DMARDs is appropriate for the patient?
A. Methotrexate
B. Leflunomide
C. Hydroxycloroquine
D. Etanercept
C. Hydroxychloroquine along eith Sulfasalazine
A 20/F came in due to wrist pain and PIP joint swelling for 2 weeks. Famliy hx revealed RA on maternal side. What diagnostic is appropriate to confirm your diagnosis?
A. ESR
B. ANA
C. CRP
D. Anti CCP
D
Which of the ff biologic DMaRDs is a humanized MAB directed against IL 6 receptir and has been shown to increase LDL cholesterol?
A. Anti TNF
B. Rituximab
C. Anakinra
D. Tocilizumab
D
What is the most common cause of death in RA?
Ischemic heart disease
In the new classification criteria for RA, it should have a score of ____ to fulfill the requirements for definite RA
More than or equal to 6
True for the DMARDs used in the tx of RA
A. Anakinra is a tnf alpha inhibitor administered subcutaneously
B. Liver function tests are measured every 2-3 months when using hydroxychloroquine
C. Eye exam if > 40 yrs old or with previous eye disease is warranted when using rituximab
D. Leflunomide and methotrexate are contraindicated in pregnancy
D
A. Anakinra = 1L1 antagonist
LFTs measured during methotrexate therapy
Eye exam warranted during tx with hydroxychloroquine
A 40 yr old female came in for consult due to joint pains localized at MCP, PIP and wrists with symmetrical involvement for 2 months. Labs revealed high positive RF and high ESR. You are considering RA, the ff are pathologic hallmarks except?
A. Formation of pannys
B. Synovial inflammation and proliferation
C. Synovial lining hyperplasia
D. Double contour sign on articular cartilage
D
Seen on Goit
True for the clinical features of RA
A. Established RA mostly involves the distal interphalangeal joints (DIP)
B. Trigger finger is due to flexor tendon tenosynovitis
C. Boutonniere deformity is due to flexion of DIP joint and hyperextension of PIP joint
D. Swan neck deformity is due to hyperextension of PIP joint and flexion of DIP joint
D
A. Usually involves the PIP
B. True but not sure if this is the answer
Boutonniere - flexion of PIP, hyperextension of DIP
A rare subset of pulmonary nodulosis characterized by the development of nodules and pneumoconiosis following silica exposure
Caplan’s syndrome
True for the extraarticular conditions assoc with RA
A. Osteoporosis is least common in RA
B. Most common cause of death is cardiovascular disease
C. Hyperandrogenism is common in males
D. Postmenopausal women have higher LH levels than control
B
A. Osteoporosis common
Hypoandrogenism
What is the most common cardiac manifestation of RA?
Pericarditis
A 30 yr old female consult at your clinic with flexion of PIP joint with DIP hyperextension. RA is considered. This clinical presentation is consistent with what joint findings?
Boutonniere deformity
Pathological hallmarks of RA
Synovial inflammation and proliferaton
Focal bone erosions
Thinning of articular cartilage
True statement regarding hydroxychloroqine?
A. Eye exam for baseline then every 2 yrs
B. Dose should be < 5mg/kg or 200-600mg/day
C. Advised for baseline electrophysiology cardiology referral
D. Irreversible retinal damage
D. Irreversible retinal damage (serious toxicity)
Eye exam = baseline then q12 months
Dose should be <5 or 200-400
A pt with RA got pregnant, her UTZ revealed 6 weeks embryo. She is still actively complaining of polyarthritis and joint swelling. What is your medical advise and mgt?
A. Hold hydroxychloroquine
B. Advise that among 75% of female RA pregnant pts noted eith improvement of symptoms during pregnancy
C. Safest dmards are sulfasalazine and leflunomide
D. Biologic agents sre generally acceptable during pregnancy
B
Which of the ff descriptions match the socalled “piano-key movement” in RA?
A. Hyperextebsion of the PIP joint with flexion of the DIP
B. Sublaxation of the first MCP joint with hyperextension of the 1st interphalangeal joint
C. Sublaxation of the distal ulna
D. Flexion of the PIP with hyperextension of the DIP
C
A. Swan neck
B. Z line
D. Boutonniere
Which of the ff joint is least likely involved in RA?
A. Wrists
B. MCP
C. PIP
D. DIP
D
If with DIP, usually with coexistent OA
Which part of the spine is more commonly involved in RA which can cause compressive myelopathy and neurologic dysfunction?
Cervical spine
Frequent hallmark of RA which leads to decreased range of motion, reduced grip strength and trigger finger
Flexor tendon tenosynovitis
Most common flexor tendon to be affected by RA: Flexor pollicis longus
Most common pulmonary manifestation of RA
Pleuritis
May produce pleuritic chest pain and dyspnea
Most common pulmonary manifestation of RA
Pleuritis
May produce pleuritic chest pain and dyspnea
Main histologic and radiologic patterns of ILD seen in RA
Usual interstitial pneumonia (UIP)
Nonspecific interstitial pneumonia (NSIP)
HRCT findings: Infiltrative opacification or ground glass opacities in the periphery of both lungs
Most common valvular abnormality in RA
Mitral regurgitation
Typically occurs in patients with long standing disease, positive for Serum RF or Anti CCP antibodies and hypocomplimentemia
Rheumatoid vasculitis
Occurs in <1%
Cutaneous signs vary and include petechiae, purpura, digital infarcts, gangrene, livedo reticularis and in severe cases large, painful lower ext ulcerations
Most common hematologic abnormality in pts with RA
Normochromic, normocytic anemia
Defined by clinical triad of neutropenia, splenomegaly and nodular RA
Felty’s syndrome
Seen in <1% of pts
Occur in late stages of severe RA
More common in whites
This condition which occurs in association with RA is characterized by a chronic, indolent clonal growth of LGL cells leading to neutropenia and splenomegaly
T cell large granular lymphocyte leukemia (T-LGL)
Vs Felty’s
This may develop early in the course
Most common histopathologic type of lymphoma whoch has two to 4 fold increased ridk of lymphoma in RA pt
Diffuse large B cell lymphoma
Epidemiology of RA
Affects 0.5 to 1% worlwide
Females > males 2-3:1 ratio
It has been hypothesized that the immune response to this organism may trigger the development of RA
Porphyromonas gingivalis
Classification criteria for RA
Classification criteria for RA
A rare condition which is typically characterized by prominent distal limb pitting edema which may be confused eith early RA
Remitting seronegative symmetrical synovitis with pitting edema
RS3PE syndrome
Usually responsive to treatment with low doses of prednisone
Laboratory feature showing the most value for predicting worse outcomes
Anti CCP antibodies
