Rheumatoid Arthritis

Question 1

Define Rheumatoid Arthritis?

Answer 1

Chronic inflammatory systemic disease characterised by symmetrical deforming polyarthritis and extra-articular manifestations

Question 2

What is the aetiology of Rheumatoid Arthritis?

Answer 2

Autoimmune disease 
UNKNOWN cause 
Associated with other autoimmune disease (e.g. Sjorgen's syndrome)
HLA associations:
- HLA-DR1 
- HLA-DR4

Question 3

What is the epidemiology of Rheumatoid Arthritis?

Answer 3

COMMON
1% of general populations
3x more common in FEMALES
Peak incidence: 30-50 yrs

Question 4

What are the presenting symptoms of Rheumatoid Arthritis?

Answer 4

Gradual onset 
Joint Pain 
Swelling 
Morning stiffness 
Impaired function 
Usually affect peripheral joints symmetrically 
Systemic Symptoms

Question 5

What are the systemic symptoms of Rheumatoid Arthritis?

Answer 5

Fever
Fatigue
Weight Loss

Question 6

What are the signs of Rheumatoid Arthritis on physical examination?

Answer 6

Arthritis - most common in the HANDS 
Early Signs 
Late Signs
Rheumatoid Nodules
Signs of complications

Question 7

What are the Early Signs of Rheumatoid Arthritis?

Answer 7

Splindling of fingers
Swelling of MCP and PIP joints
Warm, tender joints
Reduction in range of movement

Question 8

What are the late signs of Rheumatoid Arthritis?

Answer 8

Symmetrical deformign arthropathy
Ulnar deviation of fingers as a result of subluxation (partial dislocation) of the MCP joints
Radial deviation of the wrist
Swan neck deformity 
Boutonniere deformity 
Z deformity of the thumb
Trigger finger 
Tendon rupture 
Wasting of small muscles of the hand 
Palmar erythema

Question 9

What is a Trigger Finger for Rheumatoid Arthritis?

Answer 9

Inability to straighten the finger, tendon nodule palpable

Question 10

What are Rheumatoid Nodules?

Answer 10

Firm subcutaenous nodules

Usually found on the elbows, ulnar margin, palms and over extensor tendons

Question 11

What bloods do we do for Rheumatoid Arthritis?

Answer 11

FBC
High ESR and CRP
Rheumatoid factor
Antinuclear antibodies (30%)

Question 12

What do we see specifically on a FBC for Rheumatoid Arthritis?

Answer 12

low Hb

High platelets

Question 13

Why do we do Rheumatoid Factor for Rheumatoid Arthritis?

Answer 13

Found in 70% of RhA patients

The presence of rheumatoid factor is associated with rheumatoid nodules and extra-articular manifestations

Question 14

When do we do Joint Aspiration for Rheumatoid Arthritis?

Answer 14

May be performed in the acute setting to rule out septic arthritis

Question 15

What do we see on a Joint X-Ray for Rheumatoid Arthritis?

Answer 15

DONS 
Deformity 
Osteopaenia 
Narrowing of joint space 
Soft tissue swelling