Rheumatology

Osteoarthritis

Rheumatoid Arthritis

Miscellaneous

  • Rheumatoid Arthritis

  • Is rheumatoid arthritis more common in men or women?

  • Women

  • What is the approximate ratio of rheumatoid arthritis in women compared to men?

  • 3:1

  • List the triad of key symptoms occurring in rheumatoid arthritis

  • 1) Joint pain

    2) Joint swelling

    3) Joint stiffness

  • When during the day is joint stiffness typically worse?

  • Morning

  • Approximately how long does morning joint stiffness last for?

  • At least 30 minutes

  • What is the pattern of joint involvement?

  • Symmetrical distal polyarthritis

  • Which 2 small joints of the hands are typically affected?

  • 1) Metacarpophalangeal (MCP) joints

    2) Proximal interphalangeal (PIP) joints

  • Which metatarsophalangeal joints are most commonly affected?

  • Second to fifth

  • How is the C-reactive protein (CRP) level typically affected?

  • Elevated

  • How is the erythrocyte sedimentation rate (ESR) level typically affected?

  • Elevated

  • How is the haemoglobin level often affected?

  • Reduced – anaemia of chronic disease

  • How is the platelet count often affected?

  • Increased – thrombocytosis

  • Approximately what percentage of patients test positive for rheumatoid factor?

  • 70-80%

  • Approximately what percentage of healthy individuals test positive for rheumatoid factor?

  • 5-10%

  • Rheumatoid factor is most often which class of antibody?

  • Immunoglobulin M (IgM) - although can be any class

  • Which antibody does rheumatoid factor target?

  • Immunoglobulin G (IgG) Fc portion

  • Other than rheumatoid factor, which other serological marker is helpful in diagnosing rheumatoid arthritis?

  • Anti-citrullinated peptides/protein antibodies

  • Approximately what percentage of patients test positive for anti-citrullinated peptides/protein antibodies?

  • 70-80%

  • List 4 radiographic features of rheumatoid arthritis

  • 1) Joint space narrowing

    2) Bony erosions

    3) Periarticular osteopenia

    4) Joint deformity

  • Which region of the axial skeleton may be affected?

  • Cervical spine, particularly C1 to C2

  • Where does atlantoaxial subluxation occur?

  • Cervical spine – C1 to C2

  • Which vertebra is also known as the ‘atlas’?

  • C1

  • Which vertebra is also known as the ‘axis’?

  • C2

  • What is an emergency complication of atlantoaxial subluxation?

  • Spinal cord compression

  • How may the elbow joints be affected?

  • Fixed flexion with loss of extension

  • What is the commonest skin manifestation of rheumatoid arthritis?

  • Rheumatoid nodules

  • What is the commonest site for subcutaneous rheumatoid nodules?

  • Extensor surface of the elbow

  • What abnormality may develop in the popliteal fossa?

  • Popliteal (Baker’s) cyst

  • Which cell type is predominantly found in synovial fluid aspirate?

  • Polymorphonuclear cells

  • How do synovial fluid C3 and C4 complement levels compare to serum levels?

  • Reduced in synovial fluid compared to higher levels in serum

  • List the triad of Felty’s syndrome

  • 1) Seropositive rheumatoid arthritis

    2) Splenomegaly

    3) Neutropenia

  • What is the commonest neurological manifestation of rheumatoid arthritis?

  • Carpal tunnel syndrome

  • Which DMARD (disease-modifying antirheumatic drug) is generally first-line in the treatment of rheumatoid arthritis?

  • Methotrexate

  • What is the frequency of dosing of methotrexate in the treatment of rheumatoid arthritis?

  • Once weekly

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