Rheumatoid Hands OSCE

Question 1

Examine the patient’s hands: MSK diseases

Answer 1

OA, RA, psoriatic arthritis, gout, Dupuytren’s contracture

Question 2

Examine the patient’s hands:Neurological

Answer 2

Median nerve palsy/carpal tunnel, radial nerve palsy, ulnar nerve palsy

Question 3

Examine the patient’s hands:Endocrine

Answer 3

Thyroid disease, acromegaly

Question 4

Examine the patient’s hands: Other

Answer 4

Finger clubbing, scleroderm, leuconychia, koilonychia

Question 5

Features of active RA (5)

Answer 5

Inflammed joints: Red, hot, tender, swollen
Pain on passive movement 
Morning stiffness
Raised ESR
Anaemia

Question 6

Extra-articular features: General (4)

Answer 6

General malaise, lethargy, weight loss, low grade fever

Question 7

Extra-articular features: CVS (2)

Answer 7

Pericarditis, pericardial effusion

Question 8

Extra-articular features: Resp (2)

Answer 8

Pulmonary fibrosis, pulmonary effusion

Question 9

Extra-articular features: Neuro (3)

Answer 9

Polyneuropathy, mononeuritis multiplex, carpal tunnel

Question 10

Extra-articular features: Eyes (4)

Answer 10

Scleritis, episcleritis, keratoconjunctivitis sicca, Sjorgen syndrome

Question 11

Extra-articular features: Blood(

Answer 11

Anaemia, reduced white cell count, thrombocytosis

Question 12

Felty’s syndrome (3)

Answer 12

1. Reduced WCC
2. Splenomegaly
3. RA

Question 13

Causes of Anaemia in RA(5)

Answer 13

1. Anaemia of chronic disease
2. Iron deficiency anaemia secondary to NSAID induced gastritis/ peptic ulcer
3. Aplastic anaemia secondary to DMARD
4. Macrocytic anaemia secondary to methotrexate - affects folate metabolism
5. Pernicious anaemia assoc.with RA

Question 14

Findings on RA x-ray(5)

Answer 14

1. Loss of joint space
2. Bony erosion
3. Periarticular osteoporosis
4. Deformity- sublaxation
5. Soft tissue swelling

Question 15

Findings on OA x-ray (4)

Answer 15

1. Loss of joint space
2. Osteophytes
3. Subchondral sclerosis
4. Bone cysts

Question 16

DMARDs S/E: General

Answer 16

1. Marrow suppression
2. Hepatotoxicity
3. Rash
4. GI upset( Nausea and oral ulcers)

Question 17

DMARDs S/E: Methotrexate(3)

Answer 17

1. Pulmonary fibrosis
2. Megaloblastic anaemia
3. Pneumonitis

Question 18

DMARDs S/E: Cyclosporin

Answer 18

Renal impairment
HTN
Gum hypertrophy

Question 19

Psoriatic arthropathy

Answer 19

Psoriatic arthritis is a form of arthritis that affects 10% of people with psoriasis — a condition that features red patches of skin topped with silvery scales.

Question 20

Presentation of Psoaritic arthropathy

Answer 20

1. Asymmetric olgioarthritis- Dactylitis(hands and feet) mainly
2. Distal interphalangeal joints
3. Rheuamtoid pattern
   Arthritis mutilans
4. Sacroilitis

Question 21

RA Stats

Answer 21

1. 3 females > 1 male
2. 30-50 y.o
3. 70% seropositive- RF +ve IgM against self IgG.
4. 20% have extraarticular features.
5. HLA-DR4+ve- severe erosive disease

Question 22

Presenting findings of RA

Answer 22

There is a symmetrical, deforming polyarthropathy affecting the small joints of the hands in a rheumatoid pattern. The most common differentials would be RA and psoriatic arthritis.