rheumatoid arthiritis

Question 1

peak age of onset of rheumatoid arthritis ?

Answer 1

30 years , moree common in females

Question 2

genetic association with RA ?

Answer 2

HLA-DR4 and DR1

Question 3

what is the most influential non genetic factor ?

Answer 3

smoking

Question 4

what is the essential step associated with. thee pathogenesis of RA ?

Answer 4

citrullination
process of converting arginine to citrulline by PADs enzyme

Question 5

what is the etiology of pannus formation ?

Answer 5

arrangement of T cells and B cells in the centre and plasma cells and macrophages in the periphery

Question 6

which cells produce RF ?

Answer 6

B cells

Question 7

which joints are most commonly affected in RA ?

Answer 7

small joints of thee hands MCP and PIP most commonly except DIP
wrists
elbows
shoulders
knees
ankles

Question 8

what are the different patterns of presentation of RA ?

Answer 8

1- insidious onset starting off in the small joints of the hands and feet and progresses to larger joints

2- abrupt acute polyarthritis

3- acute monoarthritis

4- palindromic rheumatism ( flares come and go)

Question 9

what are the different types of hand deformities ?

Answer 9

ulnar deviation of the MCP
radial deviation of the wrist
boutonniere deformity of the wrist
swan neck deformity of thee fingers
Z deformity of thee thumb

Question 10

extra articular manifestations ?

Answer 10

fatigue and weight loss
morning stiffness
subcutaneous nodules in RF +ve pts which develop at thee sites of pressure

Question 11

what are thee ocular manifestations associated with RA ?

Answer 11

keratoconjunctivitis sicca
episcleritis
scleritis
scleromalacia
scleromalacia perforans

Question 12

triad of sjogren syndrome ?

Answer 12

dry eyes
dry mouth
RA

Question 13

how to differentiate between scleritis and episcleritis ?

Answer 13

Vessels blanch with 10% phenylephrine drops in episcleritis

Question 14

what are the pulmonary features associated with RA ?

Answer 14

pleeuritiis
pulmonary nodules
pulmonary fibrosis
caplan’s syndrome - pneumoconiosis associateed with coal miners

Question 15

most common cardiac manifestation in RA ?

Answer 15

pericarditis

Question 16

renal manifestations in RA ?

Answer 16

renal amyloid
glomerulonephritis ( related to drugs )

Question 17

what are the vascular manifestations associated with RA ?

Answer 17

nail fold splinter hge
small vessel vasculitis - mononeuritis multiplex

Question 18

what are the neurological manifestations associated with RA ?

Answer 18

cervical cord compression - subluxation at the atlantoaxial joint ( between C1 and C2 )
carpal tunnel syndrome
peripheral neuropathy - mild glove and stock sensory loss
mononeuritis multiplex

Question 19

haematological manifestations of RA ?

Answer 19

normochromic, normocytic anaemia + impaired iron utilization
thrombocytosis

Question 20

labs for RA ?

Answer 20

CBC
ESR
urea and creatinine , liver function
RF ( IgM antibody directed against Fc portion of IgG)
Anti CCP antibody

Question 21

most specific test in RA ?

Answer 21

anti CCP

Question 22

can healthy people bbee RF +vee ?

Answer 22

yes

Question 23

can healthy people be anti-ccp +ve ?

Answer 23

rarely

Question 24

which has a worse prognosis RF +ve or RF -ve ?

Answer 24

RF +ve

Question 25

how is RF detected ?

Answer 25

agglutination methods

Question 26

what are thee ACR criteria for diagnosis of RA ?

Answer 26

* Patients must have 4 of 7 criteria – Morning stiffness lasting at least 1 hour* – Swelling in 3 or more joints* – Swelling in hand joints* – Symmetric joint swelling* – Erosions or decalcification on X-ray of hand – Rheumatoid nodules – Abnormal serum Rheumatoid factor must be present for at last 6 weeks

Question 27

main line of treatment ?

Answer 27

DMARDs along with NSAIDs

Question 28

contraindications to NSAIDS ?

Answer 28

peptic ulcer history renal impairment asthma

Question 29

what are the DMARDS ?

Answer 29

disease modifying drugs : methotrexate hydroxychloroquine and chloroquine penicillamine leflunomide salazopyrin

Question 30

drug of choice in early aggressive joint disease ?

Answer 30

methotrexate

Question 31

Side effects of methotrexate ?

Answer 31

bone marrow suppression and hepatotoxicity monitor liver function and perform CBC regularly

Question 32

SE of hydroxychloroquine ?

Answer 32

skin pigmentation retinopathy myopathy

Question 33

SE of salazopyrin ?

Answer 33

skin rashes liver abnormalities

Question 34

SE of leflunomide ?

Answer 34

diarrhea alopecia rash abnormal LFT

Question 35

types of immunosuppressants ?

Answer 35

azathioprine cyclophosphamide cyclosporine

Question 36

SE off each immunosup ?

Answer 36

cyclophosphamide - hgec cystitis azathioprine - BM suppression and malignancy cyclosporine - HTN and creatinine rise

Question 37

biologic drugs used in RA ?

Answer 37

selective immunosuppressants that target the activity of TNF : infliximab ( must be combined with methotrexate )