Rheumatoid Arthritis

Question 1

What are the symptoms suggesting RA?

Answer 1

• Early morning stiffness for lasting longer than an hour
• Symmetrical joint involvement - wrist, MCPJ, PIPJ, metatarsaphalangeal joint involvement
• Swelling of 5 or > joint s
• Tender on compression of metatarsophalangeal joints
• symptoms present for longer than 6 weeks
• presence of rheumatoid nodules
• Family history of inflammatory arthritis

(Ref etg)

Question 2

In addition to character of the joint pain what other Questions on history would you ask for a patient with joint pain?

Answer 2

Any recent viral illness? 
Extra-articular features such: dryness symptoms, rash, mouth ulcers or Raynaud’s phenomenon?
Systemic symptoms aweight loss, fatigue,
fever or night sweats
Functional impairment?

Family history of psoriasis, RA or other
autoimmune disease?

Smoking?

(Ref bones and joints check 2015)

Question 3

How specific is anti-CCP for RA?

Answer 3

96% specific (Ref etg)

Question 4

Is Rheumatoid Factor always positive in RA?

What are some other conditions that are associated with RhF +ve

Answer 4

RhF poor specificity. It’s +ve in 70% of patients, but may not be present in early disease (Ref etg)

SLE, Sjögren’s syndrome, chronic infections,
cryoglobulinaemia, lymphoproliferative disorders

Question 5

What are features that indicate a poor prognosis?

Answer 5

• a high RF titre and/or a positive anti-CCP antibody test
• sustained raised inflammatory markers (CRP or ESR)
• swelling in more than 20 joints
• impaired function early in disease
• bony erosions evident on X-rays early in disease
• smoking

(Ref etg)

Question 6

Mimickers of RA?

Answer 6

Viral polyarthritis: parvovirus B19, hepatitis B, hepatitis C andmosquito-borne viruses (eg Ross River and Barmah Forest)can cause symmetrical polyarthritis that can mimic RA.

Sarcoid arthropathy: sarcoidosis may cause an inflammatory polyarthritis with a similar pattern of joint involvement as RA.

SLE

Ref Check Bones and Joints 2015

Question 7

What are some xray changes in RA?

Answer 7

• periarticular osteopaenia
• soft tissue swelling,
• joiny space narrowing
• bony erosions
• joint deformity in late disease

Ref Check Bones and Joints 2015