Rheumatoid Arthritis

Question 1

What is rheumatoid factor?

Answer 1

an IgM antibody which recognizes and attacks native IgG antibodies
immune complex is then deposited in end tissues like the kidney as part of the pathophysiology

Question 2

What is the cascade of events in rheumatoid arthritis?

Answer 2

1) antigen-antibody and antibody-antibody reactions >
2) microvascular proliferation and obstruction >
3) synovial pannus formation (histology shows prominent intimal hyperplasia) >
4) joint subluxation, chondrocyte death/joint destruction, and deformity >
5) tendon tenosynovitis and rupture

Question 3

What are the signs and symptoms of rheumatoid arthritis?

Answer 3

1) insidious onset of morning stiffness and polyarthropathy
2) usually affects hands and feet; DIP joint of hand is usually spared
3) periarticular erosions on xray
4) subcutaneous nodules in 20%

Question 4

What disease is Anti-CCP the most sensitive and specific test?

Answer 4

Rheumatoid; RF present in 70-80% of pts

Question 5

Which medication when combined with methotrexate has been shown to be more effective than methotrexate alone in the treatment of rheumatoid arthritis?

Answer 5

doxycycline

Question 6

What substances are TNF-alpha antagonists?

Answer 6

Enteracept, Infliximab, Adilimumab

Question 7

What is the MOA of rituximab?

Answer 7

monoclonal antibody to CD20 antigen (inhibits B cells)

Question 8

What is the pathoanatomy of ulnar drift of digits in rheumatoid?

Answer 8

1) joint synovitits >
2) radial hood sagittal fiber stretching >
3) concomittant volar plate stretching
4) extrinsic extensors subluxate ulnarly >
5) lax collateral ligaments allow ulnar deviation deformity >
6) ulnar intrinsics contract further worsening the deformity >
7) wrist radial deviation further worsens >
8) flexor tendon eventually drifts ulnar

Question 9

Vaughn-Jackson syndrome in rheumatoid arthritis is best described as?

Answer 9

rupture of the hand digital extensor tendons which occur from the ulnar side of the wrist first then moves radially

Question 10

What are classic hip and shoulder radiographic findings in RA patients?

Answer 10

central glenoid wear
periarticular osteopenia
cysts

acetabular protrusio of the hip

Question 11

When should immunosuppressive in the treatment of RA be discontinued prior to surgery?

Answer 11

1) etanercept should be discontinued 3 days prior to surgical procedures
2) adalimumab should be discontinued 10 days prior to surgery
3) the lowest level of infliximab is found 2 weeks prior to the next scheduled infusion