Rheumatoid Arthritis

Question 1

Clinical findings of RA

Answer 1

PIP joint swelling
Ulnar deviation with volar subluxation
Swan neck deformity
Atlanto-axial subluxation (cervical spine)
80% positive for RA, others become positive later

Question 2

When does RA present in women?

Answer 2

fifth decade of line

Question 3

Name some extra articular manifestations of RA

Answer 3

Episcleritis
Pericarditis
Subcutaneous nodules
Splenomegaly

Question 4

Define

Answer 4

Chronic systemic inflammatory disease

Question 5

Which joints are affected?

Answer 5

Symmetrical, polyarticular disease of
SMALL JOINTS
- PIP
-MCP
-MTPJ

Weight bearing joints are rarely affected

Question 6

Predisposing factors

Answer 6

Female>male
Age 30-50years
FH

Question 7

Typical presentation

Answer 7

Morning stiffness that improves with use
Synovitis - pain, swelling, heat and stiffness
Symmetrical
Extra articular features

Question 8

What xtra articular featuers may be present?

Answer 8

Eyes
Lung
Heart
Vasculitis
Nodules
Joint deformity

Question 9

What two deformities might you see?

Answer 9

Hyperextention of PIP

Swan neck defority

Question 10

What is found in 80% of patients?

Answer 10

Anti-CCP antibodies are found

Question 11

What is found in 80% of patients?

Answer 11

Anti-CCP antibodies are found (higher specificity that rheumatoid factor)

Question 12

Investigations

Answer 12

RF
Anti-CCP
XR hands and feet

Question 13

Management

Answer 13

Consider NSAID

DMARD

Question 14

Give examples of NSAIDs

Answer 14

Methotrexate
Leflunomide
Sulfasalazine

Question 15

What else could you get with RA?

Answer 15

Felty’s syndrome

Question 16

What is felty’s syndrome?

Answer 16

RA
SPlenomegaly
Low WCC