Rheumatoid arthritis

Question 1

Define rheumatoid arthritis

Answer 1

Chronic inflammatory systemic disease characterised by symmetrical deforming polyarthritis & extra articular manifestations

Question 2

Aetiology of rheumatoid arthritis

3

Answer 2

AUTOIMMUNE disease
UNKNOWN cause
Associated w/ other autoimmune disease (e.g. Sjogren’s syndrome)

Question 3

HLA association of rheumatoid arthritis

2

Answer 3

HLA-DR1

HLA-DR4

Question 4

Epidemiology of rheumatoid arthritis

prevalence x2, gender, age

Answer 4

COMMON
1% general population
3x more common in females
Peak incidence 30-50 yrs

Question 5

Presenting symptoms of rheumatoid arthritis

6

Answer 5

Gradual onset
Joint pain
Swelling
Morning stiffness
Impaired function 
Usually affects peripheral joints symmetrically

Question 6

Presenting symptoms of rheumatoid arthritis - systemic

3

Answer 6

Fever
Fatigue
Weight loss

Question 7

Signs of rheumatoid arthritis on physical examination

general + 2 groups

Answer 7

Arthritis - most common in the HANDS

Early signs
Late signs

Question 8

Signs of rheumatoid arthritis on physical examination - early
(4)

Answer 8

Spindling of fingers
Swelling of MCP & PIP joints
Warm, tender joints
Reduction in range of movement

Question 9

Signs of rheumatoid arthritis on physical examination - late

7

Answer 9

Symmetrical deforming arthropathy

Ulnar deviation of fingers as a result of subluxation of MCP joints

Radial deviation of wrist

Swan neck deformity

Boutonniere deformity

Rheumatoid nodules

Signs of complications

Question 10

Define subluxation

Answer 10

partial dislocation

Question 11

Investigations for rheumatoid arthritis

3 types

Answer 11

Bloods
Joint aspiration
Joint xray

Question 12

Investigations for rheumatoid arthritis - bloods

4

Answer 12

FBC - low Hb, high platelets
High ESR & CRP
Rheumatoid factor (found in 70% patients)
Antinuclear antibodies (30%)

Question 13

Investigations for rheumatoid arthritis - joint aspiration

Answer 13

May be performed in acute setting to rule out septic arthritis

Question 14

Investigations for rheumatoid arthritis - joint X-ray

4

Answer 14

(DONS)
Deformity
Osteopenia
Narrowing of joint space
Soft tissue swelling

Question 15

Boutonniere deformity
(5)

Answer 15

Z deformity of thumb
Trigger finger (inability to straighten finger, tendon nodule palpable)
Tendon rupture
Wasting of small muscles of hand
Palmar erythema

Question 16

Rheumatoid nodules

describe + location

Answer 16

Firm subcutaneous nodules

Usually found on elbows, ulnar margin, palms & over extensor tendons