Rheumatoid Arthritis

Question 1

What is arthritis?

Answer 1

Question 2

Recall the prevalence of self-reported arthritis in Australia.

Answer 2

Question 3

Define RA and its consequences.

Answer 3

Question 4

What is the primary manifestation of RA?

Answer 4

Synovitis => erosion of bone, cartilage, peri-articular structures

Question 5

Recall the epidemiology of RA.

Answer 5

Question 6

Recall the structural difference between normal and RA joints.

Answer 6

Question 7

Mention the articular manifestations of RA.

Answer 7

• Morning Stifness
  
  • Cardinal symptom
  • Accumulation of fluid within inflamed tissues during sleep
  • Dissipates as oedema, products of inflammation absorbed by lymphatics and venules - returned to the circulation by movement
  • Gel phenomenon if inactive during day
• Pain
• Swelling

Question 8

Recall the distribution of joint involvements in RA.

Answer 8

Question 9

Recall the basic hand anatomy.

Answer 9

Question 10

Recall the characteristic and mechanism of Boutonniere deformity.

Answer 10

Characterised by:

• fixed flexion deformity of the PIP joint
• Fixed hyperextension of the DIP joint

Mechanism:

• protrusion the PIP joint through its ruptured extensor tendon

Question 11

Recall the mechanism of swan neck deformity.

Answer 11

Question 12

How do you observe MCP swelling?

Answer 12

No hill and valleys between the knuckles.

Question 13

What is subluxation?

Answer 13

Subluxation is an incomplete or partial dislocation of a joint.

Question 14

Describe the mechanism of the Z deformity of the thumb.

Answer 14

Question 15

Recall the radiographic features of RA wrist.

Answer 15

Question 16

Recall again the typical hand deformities of RA.

Answer 16

Question 17

Recall the basic foot anatomy.

Answer 17

Question 18

In which part of the spine does RA affect?

Answer 18

Atlantoaxial Joint

Question 19

Recall the ultrasonographic features of RA hand.

Answer 19

Question 20

What would the Power Doppler mode in an ultrasound detect?

Answer 20

It detects blood flow.

Question 21

Recall the MRI findings in RA hand.

Answer 21

Question 22

Recall radiographic features of RA feet.

Answer 22

Question 23

Recall the extra-articular manifestations of RA.

Answer 23

Question 24

Mention examples of extra-articular manifestations of RA.

Answer 24

Rheumatoid nodules

• for positive rheumatoid CCP patients
• a central area of necrosis surrounded by a collagenous capsule
• Occurs at sites of pressure
• Signs of poorer prognosis - more aggressive treatment

Episcleritis

• Red eye - medical emergency
• Signs of rheumatoid arthritis
• Leads to scarring of eye - progressive sight loss

Scleromalacia

• erode collagen of the surface
• No treatment - effects on sight loss

Question 25

How do diagnose pulmonary nodules in X-ray?

Answer 25

Pulmonary nodules could be either lymphoma caused by RA or smoking-related cancer. To determine usually a surgical biopsy would be done.

Question 26

Describe the mechanism of digital vasculitis.

Answer 26

Spots of tissue necrosis due to swelling of joint compressing the blood vessel supplying the region.

Question 27

Describe pyoderma gangrenosum.

Answer 27

Pyoderma gangrenosum is a rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow (eroding soft tissue). Treatment includes cleaning the wound, remove necrotic tissue, and immune suppress the patients.

Question 28

Recall the common articular manifestations of Hand Osteoarthritis.

Answer 28

Question 29

Recall radiographic features of hand OA.

Answer 29

Question 30

Recall the difference between RA and OA.

Answer 30

Question 31

Recall the pattern of joint involvement of RA and OA.

Answer 31