Rheumatoid Arthritis

Question 1

is RA symmetric or asymmetric

Answer 1

symmetric

Question 2

Impt markers for RA:

Answer 2

RF + anti-CCP

Question 3

Why is RA a multigene dz

Answer 3

bc genetic factors (hla-drb4 + drb1) claim 60% risk for RA; espec with severe RA

Question 4

infiltration of what in RA:

Answer 4

leukos, cytokines, macrophages –> activate T cells

B lymphocytes then produce autoantibodies, cytokines (TNFa, IL-1, IL6), proinflammatory cytokines–> synovial proliferation, increase synovial fluid –> Pannus that invades cartilage and bone

Question 5

imaging for RA

Answer 5

xray of hands + feet (detect symmetrical involvement of MCP/MTP joints; erosions)

Ct- more sensitive for detecting erosions

Question 6

tx RA:

Answer 6

begin NSAID for pain control

early use of DMARD (methotraxate)

may need low dose of steroid for a few weeks

monitor progress + toxicity

Question 7

epidemio of RA

Answer 7

W»M; 20-60 y/o

improves during pregnancy (flare 4-6 weeks after)

Question 8

Swan neck:

Answer 8

hyperextension of PIP joints; flexion DIP

Question 9

Boutonniere:

Answer 9

button hole deformity; hyperflexion of PIP

Question 10

RA in wrist can lead to

Answer 10

carpal tunnel syndrome

Question 11

RA in knees can also have

Answer 11

baker cysts

Question 12

RA in neck

Answer 12

C1-C2; may subluxation

Question 13

RA clinical manifestations:

Answer 13

pain, swelling, warmth in multiple small joints (<3 of hands and/or feet)

morning stiffness >1 yr

<10% = abrupt onset of dz

active sign of inflammation at least 6 weeks (dx)

Question 14

extra articular manifestations of RA more common in:

Answer 14

RF+ or anti-CCP +

subq nodules @extensor surface of forearm

Question 15

Complications of RA:

Answer 15

pyroderma gangrenosum
Rheumatoid vasculitis
CAD
Felty Syndrome

Question 16

can see rheumatoid nodules in

Answer 16

coal miners pneumoconiosis w/ nodular opacities

Question 17

you can get extra-articular manifestations of RA due to a secondary ____

Answer 17

Sjogrens syndrome (keratoconjunctivitis sicca)

Question 18

What test support a dx of Sjogrens?

Answer 18

Ro/SS-a, La/SS-B
Schirmer test (litmus paper)
Slit-lamp exam

Question 19

tx of Sjogrens

Answer 19

anti-inflammatory and immunosuppressive

Question 20

is there a single finding on physical exam or lab test that is pathognomonic of RA?

Answer 20

NO

Question 21

tx moto for RA

Answer 21

treat early to prevent irreversible cartilage and bone damage; goal = dz remission (possible in 50% if tx early)