Rheumatology -Finley

Question 1

What is the #1 cause of disability in the US?

Answer 1

Rheumatic disease–> diseases characterized by pain and inflammation
in joints and connective tissues

Question 2

What are the primary, secondary and tertiary preventive strategies for rheumatic diseases?

Answer 2

Primary – prevention/vaccine for Lyme

Secondary – early Dx

Tertiary – treatment o prevent death/disability

Question 3

What are the major differences between acute and chronic arthritis? What are some examples of both?

Answer 3

acute:

• Rapid onset (hours or days)
• Severe symptoms
• innate immune response, especially neutrophils
• rapid joint destruction
• Can also evolve into chronic disease
• Examples: Gout and Infectious Arthritis

Chronic:

• gradual onset (days–> weeks)
• moderate symptoms, AM stiffness change throughout day
• adaptive immune response, esp T cells
• cytokines and chronic inflammation–> joint remodeling and destruction via erosions
• ex: RA, ankylosing spondylitis, SLE, lyme disease

Question 4

What is an essential requirement for arthritis?

Answer 4

INFLAMMATION

Arthralgia-joint pain without swelling

Question 5

What is CREST syndrome? What is a common physical finding with this?

Answer 5

Calcinosis Cutis, Raynaud’s Phenomenon, Esophageal Dysfunction, Sclerodactyly, and Telangiectasia

-nail-fold capillaries will be dilated and enlarges –>

Question 6

What is onycholysis?

Answer 6

separation of the nail plate from the nail bed

Question 7

What 2 non-specific lab tests are used to measure inflammation?

Answer 7

ESR–> measures the sedimentation of RBCs and will be higher with inflammation

CRP–> synthesized in response to acute tissue injury
>6 hours –> 1 week after

Question 8

What is Rheumatoid Factor?

Answer 8

Ab binding to the Fc portion of IgG

Question 9

What lab test can be used in a pt who you suspect RA but had a negative RF?

Answer 9

Anti-CCP (cyclic citrullinated peptide)

Question 10

What are the 3 lab tests for complement function?

Answer 10

C3

C4

CH50=total hemolytic completment–> tests whether complement is functioning based off the lysis of cells

Question 11

When is a CT better than an X-ray in rheumatoid conditions?

Answer 11

certain joint conditions:

• sacroilitis
• osteonecrosis
• sternoclavicular junction

Question 12

What is DEXA used to determine?

Answer 12

bone density

Question 13

What is the HAQ (health assessment) used to determine?

Answer 13

a pts functionality
0=best 3=worst

above 2=need help–> severe loss of function

Question 14

What is currently used for the classification of RA? What are the different categories and what is considered a score for a definite RA diagnosis?

Are these diagnostic criteria?

Answer 14

joint distribution (0-5)
serology (0-3)
symptom duration (0-1)
acute phase reactants (0-1)

> or equal to 6=definite RA

NOT diagnostic criteria–> can inform the diagnosis but the diagnosis should ultimately be made by the rheumatologist

Question 15

What are some features of RA?

Answer 15

• systemic inflammatory disease
• constitutional features (fever, weight loss, fatigue)
• symmetrical erosive polyarthritis
• morning stiffness
• extra-articular manifestations (ex: nodules)
• swan neck deformity or boutonniere deformity in hands
• serolologic correlates (RF, anemia, elevated ESR and CRP, ANA)
• cock-up toe
• pannus formation from the over vascularization of the synovium
• juxta articular erosions (around the joint)
• symmetric joint space narrowing
• episcleritis: inflammation of the sclera

Question 16

What is the key to good outcome with RA?

Answer 16

early diagnosis