RHEUMATOLOGY

Question 1

What is RF?

Answer 1

Autoantibody against Fc fragment of IgG

Question 2

What is CCP / CYCLIC CITRULLINATED PEPTIDE?

Answer 2

Proteins derived when arginine converted to citrulline
Enzyme : Peptidyl arginine

Ex; Fibrinogen , type 2 collagen , vimentin , alpha enolase

Question 3

Positive RF/ rheumatoid factor
Positive ACPA/ ANTI CCPS ( almost same causes for both )

Answer 3

AI : Rheumatoid arthiritis , SLE , sjogrehs , vasculitis , PAN

INF: TB, syphillis , leprosy

Viral : hepatitis , mononucleosis

Hyperglobulinemia : CLD , ILD SARCOIDOSIS

OTHER ; genetic , age 65 or more , b cell neoplasm

Question 4

ANA ?
SIGNIFICANCE ?

Answer 4

Anti nuclear ab ( against DNA, RNA , PROTEINS )

significant only on high titre > 1:160
Used for screening of SLE , SYSTEMIC SCLEROSIS

Question 5

Positive ANA ?

Answer 5

SLE
AI HEPATITIS
SYS SCLEROSIS
DRUG INDUCED LUPUS
SJOGRENS SYNDROME POLYMYOSITIS / DERMATOMYOSITIS

Question 6

Anti Neutrophil Cytoplasmic ab …ANCA

Answer 6

IgG Ab directed against enzymes in cytoplasmic granuels of Neutrophils and lysozomes of mononcytes

Question 7

Types of ANCA

Answer 7

C-ANCA : ANTI PROTEINASE 3, produces cytoplasmic fluorescence; Wegnera granulomatosis

P- ANCA : ANTI MYELOPEROXIDASE ANCA , produces perinuclear fluorescence ; CHURG STRAUSS, MICROSCOPIC POLYANGITIS

Question 8

RA ETIOLOGY , gene environ AI sex age

Answer 8

Gene: HLA DRB1, Non - HLA : PTPN22

ENVIRONMENTAL; Smoking , viral, mycobacteria , mycoplasma

Autoimmunity

MC in female M:F=1:3

Age 30-50

Question 9

Articular manifes of RA (5)

Answer 9

Symmetrical
Involves joints : MCP, PIP ,MTP
Pitting edema on dorsum of hand - BOXING GLOVE SIGN
MORNING STIFFNESS

Question 10

RHEUMATOID HAND (10)

Answer 10

DIP spared
PIP involved - SPINDLING OF FINGERS - earliest feature
Ulnar deviation
Swan neck deformity
Button hole / Boutonniere deformity
Z deviation
Carpal tunnel syndrome
Gamekeepers thumb
Hitchikkeras thumb
bow string sign

Question 11

Foot ankle deformity of RA (4)

Answer 11

Broadening of forefoot
Hallux valgus
Hammer toes
Cockup deformity - subluxation of toes at MTP JOINT

Question 12

LARGER JOINT IN RA

Answer 12

Synovial cyst / bakers cyst
MC in knee joint , popliteal fossa
Rupture resembles DVT

ATLANTOAXIAL subluxation - Quadriparesis

Cricoarytenoid joint defect - hoarseness of voice

Question 13

Feltys syndrome 🌟 SANTA

Answer 13

Spleenomegaly 🌟
Anemia
Neutropenia🌟
Thrombocytopenia
Arthiritis rheumatoid 🌟

🌟 -triad

Question 14

Caplans syndrome 🌟 CONS of RA

Answer 14

Coal worker pneumoconiosis
Nodules peripheral 0.5-5 cm
Silicosis
Rheumatoid arthiritis

Question 15

ACR AMERICAN COLLEGE OF RHEUMATOLOGY criteria for RA

Answer 15

For more than 6 weeks :
🌟
Symmetric arthiritis
Morning stiffness
Arthiritis of more than 3 joint areas
Hand arthiritis

🌟Favour diagnosis :
RF POSITIVE
Rheumatoid nodules
Radiographic changes