Rheumatoid Arthritis Long

Question 1

RA - Extra-articular Features

Answer 1

Skin - Raynaud’s, skin ulcers
Eyes - dry eyes, scleritis, episcleritis, scleromalacia perforans
sore throat, hoarseness, or neck pain - cervical spine
lungs - interstitial fibrosis, pleural effusion, pleuritis
heart - pericarditis, valve disease
neurology - peripheral neuropathy, mononeuritis multiplex, cord compression, entrapment neuropathy
hematologic
vasculitis

Question 2

RA - signs of activity

Answer 2

Number of joints with active synovitis
severity and duration of morning stiffness
functional activity
symptoms of systemic illness

Question 3

Methotrexate - Drug Complications

Answer 3

hepatic toxicity
lung toxicity (fibrosis)
marrow toxicity
rash

• worse on drinking alcohol
• folic acid to reduce complications
  NOT FOR PATIENTS WITH G6PD

Question 4

Sulfasalazine - Drug Complications

Answer 4

rash
nausea
hematological abnormalities
abnormal liver function test
reversible oligospermia

Question 5

Penicillamine - Drug complications

Answer 5

nephrotic syndrome
thrombocytopenia
mouth ulcers
SLE
polymyositis
myasthenia gravis
Goodpasteur's syndrome

Question 6

Components of Felty’s Syndrome

Answer 6

Rheumatoid arthritis
leucopenia
splenomegaly
non-healing ulcers

• Older patients with signs of Rheumatoid disease

Question 7

Criteria for Diagnosis of RA

Answer 7

Morning stiffness >1 hour for >6 weeks
Arthritis of 3 or more joint areas 
 - soft tissue swelling of >6 weeks
Arthritis of hand joints (NOT DIP) >6 weeks
Symmetrical arthritis >6 weeks
Rheumatoid nodules
Serum RF
X-ray changes consistent with RA

*4 out of 7 diagnostic

Question 8

Xray Changes in RA

Answer 8

Soft tissue swelling
joint space narrowing
juxta-articular osteoporosis
joint erosions

Question 9

RA - Risk Factors for Destructive Disease

Answer 9

High-titre RF or positive anti-CCP
Constitutional symptoms
Insidious onset
Erosions early on xray
Rheumatoid nodules early
HLA DR4

Question 10

RA - Tests for Monitoring Drug Complications

Answer 10

Full blood count
urine testing for proteinuria
LFTs (for MTX)
Ophthal review, visual fields (Plaquinil)

Question 11

RA - Indications for Steroid Use

Answer 11

Vasculitic complications of RA
Severe progressive disease until other treatment becomes effective
chronic low-dose treatment