Rheumatology

Question 1

Most common and 2nd most common CTD?

Answer 1

RA
Sjogren

Question 2

Age and female:male ratio in RA?

Answer 2

Peak : 40-60 yrs.

Female : male ratio → 3 : 1.

Question 3

Most common arthritis?

Answer 3

Osteoarthritis

Question 4

RA Pathogenesis?

Answer 4

1. Environmental & genetic factors → abnormal protein modification (citrullination).
2. Abnormal proteins→ presented by APC (Langerhans dendritic cells) to T cells → 2 0 activation of B cells & neutrophils → Migration to joint.
3. Synovial hypertrophy (Type A> type B synoviocytes)→ Pannus formation → Bone erosion.

Question 5

Genetic factors of RA?

Answer 5

1.HLA associated factors :

• HLA-DRB104 → QKRAA aminoacid motiff (AkA shared epitope).
• HLA-DRB113 : Protective.

2. Non HLA associated factors :

• PADI-4 (Peptidyl arginine deaminase 4)
Arginine (Normal Aminoacid) to Citrulline(Abnormal aminoacid) by PADI-4
• PTPN 22

Question 6

Environmental factors of RA?

Answer 6

1. Smoking :

• Strongest risk factor.
• Associated with bad prognosis.
• risk of ILD in RA.
• expression of PADI-4 in airway.

2. Infection : Chronic periodontitis.
   Caused by Porphyromonas gingivalis.
3. Alcohol/OCP : Mild protection.

Question 7

Smoking associated ILD is seen in ?

Answer 7

Smoking associated ILD is seen in :

• Desquamative interstitial pneumonia.

• Langerhans cell histiocytosis.

• ILD in rheumatoid arthritis.

• Respiratory bronchiolitis associated ILD.

Question 8

Autoantibodies in RA?

Answer 8

Anti CCP/anti citrullinated polypeptide/mutated citrullinated vimentin.

Anti CarP

Anti PADI-4 antibody

Rheumatoid factor (RF)

Question 9

Anti CCP ?

Answer 9

• Seen in 80-90% cases of RA.

• Specificity : 95% for RA.

• Best marker for Preclinical infection

• ↑ risk of extrarticular features

Question 10

Which antibody associated with palindromic rheumatism?

Answer 10

Anti CarP

Question 11

RF?

Answer 11

• IgM directed against Fc portion of IgG.
• ↑ titre a/w ↑ disease activity.
• Specificity : 75-80%.
• Also +ve in :

a. Sjogren’s.
b. Cryoglobulinemia type 2 & 3.
c. Polyarticular JIA.

Question 12

Markers for relapse in RA?

Answer 12

ESR& CRP (Anti-CCP and RF hold no value)

Question 13

Clinical features of rheumatoid arthritis (articular)?

Answer 13

• Duration : > 6 weeks.
• B/l symmetrical.
• Intraarticular.
• Inflammatory (Indicated by morning stiffness > 45 mins).
• Peripheral small joint, upper limb polyarthritis.
• Disease starts at distal radioulnar joint.
• Joints involved/spared rheumatoid arthritis.

Question 14

Joints involved in rheumatoid arthritis?

Answer 14

• MCP.

• Wrist.

• PIP.

• C-spine

Question 15

Joints spared in rheumatoid arthritis?

Answer 15

• DIP.

• 1st CMC, 1st MTP.

• Thoracolumbar & sacral spine.

Question 16

Reversible deformities in rheumatoid arthritis?

Answer 16

1. Zigzag deformity: Radial deviation of wrist + 2. Ulnar deviation of MCP
   Subluxation of MCP joint
2. Piano key styloid: Rupture of ulnar collateral ligament
3. Hitchhiker thumb deformity: Abduction + Hyperextension of thumb

Question 17

Irreversible deformities in rheumatoid arthritis?

Answer 17

1. Boutonniere deformity: Flexion of PIP + Hyperextension of DIP
2. Swan neck deformity: Hyperextension of PIP + Flexion of DIP
3. Opera glass hand: Arthritis mutilans

Question 18

Other deformities in RA?

Answer 18

• TM joint
• C1-C2 joint : Odontoid process erosion
• Cricoarytenoid : Change in voice
• 5 th MTP : M.c involved
• Pes planus
• Forefoot varus
• Ankle valgus.