rheumatoid arthritis

Question 1

pathophysiology rheumatoid arthritis

Answer 1

80% circulating rheumatoid factor
HLA DR-4 and HLA DR-1 associated
T cells (CD4) are dominant in joint destruction
Collagenase and prostaglandins destroy cartilage

Question 2

disease modifying anti-rheumatic drugs

Answer 2

TNF blockade: remade, humor, enbrel, simponi
T cell costimulatory blocker: orencia
B cell depletion: rituxan
IL-1 receptor antagonist: anakinra (kineret)
IL-6 blockade - tocilizumab (actemra)
janus kinase inhibitor - xeljanz

Question 3

flexor tendon rupture rheumatoid

Answer 3

FPL ruptures from scaphoid tubercle friction
= Mannerfelt lesion
use EIC tendon transfer for reconstruction

Question 4

extensor tendon rupture rheumatoid

Answer 4

most common small finger (vaughan-jacksohn) and progresses radially
EIC tendon transfer for reconstruction (can use FDS as well if multiple digits)

Question 5

brewerton lesion

Answer 5

radial collateral ligament recess on X-ray. Correlated with radial deviation of metacarpals and ulnar deviation of fingers and extensor tendons

Question 6

with swan neck deformity if limited PIPJ flexion with MPJ extended

Answer 6

intrinsic tightness. may need intrinsic release and MP joint arthroplasty

Question 7

boutonniere in thumb

Answer 7

EPL subluxation and EPB attenuation