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20 Cards in this Set
- Front
- Back
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1. In whom does RA most often present?
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a. Women >50.
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2. Presentation of RA?
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a. Joint pain and morning stiffness that is symmetrical and in multiple joints of the hands lasting for more than 1 hour in the morning with the symptomatic episode going on for at least 6 weeks.
b. There is often a prodrome of malaise and weight loss, but this is not enough to make a clear diagnosis. |
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3. Definition of RA?
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a. Defined as having 4 or more of the following present for diagnosis:
3.a.1.a. Morning stiffness lasting more than 1 hour 3.a.1.b. Wrist and finger involvement (MCP, PIP) 3.a.1.c. Swelling of at least 3 joints 3.a.1.d. Symmetric involvement 3.a.1.e. Rheumatoid nodules (not necessary to diagnose RA) 3.a.1.f. X-ray abnormalities showing erosions (not necessary to diagnose RA) 3.a.1.g. Positive rheumatoid factor or anti-CCP 3.a.1.h. C-reactive protein (CRP) or ESR. |
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4. Diagnostic testing for RA?
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a. RA is diagnosed w/a constellation of physical findings, joint problems, and lab tests.
b. There is no single diagnostic criteria to confirm the diagnosis. c. There is no single therapy to control and treat the disease. |
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5. A 34 yo woman presents w/pains in both hands for the last few months and stiffness that improves as the day goes on. Multiple joints are swollen on exam. Xrays of the hands show some erosion. What is the single most accurate test?
a. Rheumatoid factor b. Anti-cyclic citrullinated peptide (anti-ccp) c. Sed rate d. ANA e. Joint fluid aspiration |
1. Answer: B-Anti-CCP!
2. Rheumatoid factor (RF) is present in only 75-85% of pts w/RA. 3. It can also be present in a number of other diseases; hence the RF is rather nonspecific. 4. Anti-CCP is the single most accurate test for RA. It is >95% specific for RA, and it appears earlier in the course of the disease than RF. 5. There is nothing specific on joint aspiration to determine the diagnosis of RA. |
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6. Other systems affected by RA?
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a. Cardiac
b. Lung c. Blood d. Nervous e. Skin |
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7. Cardiac findings in RA?
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a. Pericarditis
b. Valvular disease |
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8. Lung findings in RA?
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a. Pleural effusion w/a very low glucose level, lung nodules.
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9. Blood findings in RA?
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a. Anemia w/normal MCV
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10. Nerve findings in RA?
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a. Mononeuritis multiplex.
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11. Skin findings in RA?
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a. Nodules
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12. Joint findings in RA?
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12.a.1.a. MCP swelling and pain
12.a.1.b. Boutonniere deformity-Flexion of the PIP w/hyperextension of the DIP. 12.a.1.c. Swan neck deformity-Extension of the PIP w/flexion of the DIP 12.a.1.d. Baker’s cyst (outpocketing of synovium at the back of the knee) 12.a.1.e. C1/C2 cervical spine subluxation 12.a.1.f. Knee-Although the knee is commonly involved, multiple small joints are involved more commonly over time. |
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13. Felty’s syndrome Triad?
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13.a.1.a. RA
13.a.1.b. Splenomegaly 13.a.1.c. Neutropenia |
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14. New alternate diagnostic criteria for RA?
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14.a.1.a. Synovitis (a single joint is enough to diagnose RA)
14.a.1.b. RF or anti-CCP 14.a.1.c. ESR or CRP 14.a.1.d. Prolonged duration (beyond 6 weeks) |
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15. What type of anemia is very characteristic of RA?
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a. Normocytic normochromic.
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16. CCS Tip: In addition to X-rays, RF, and CCP, what else should you order for RA?
16.a.1.a. CBC 16.a.1.b. Sed rate 16.a.1.c. CRP |
b. If the case describes a swollen joint w/an effusion, aspiration of the joint should also be done to establish the initial diagnosis.
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17. Which of the following will have the lowest glucose level on pleural effusion?
a. CHF b. Pulmonary embolism c. Pneumonia d. Cancer e. RA f. Tuberculosis |
17.f.1.a. Answer: E- RA has the lowest glucose levels of all the causes of pleural effusion described here.
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18. Which joint in spared in RA?!?
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a. Sacroiliac.
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19. Tx of RA?
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a. NSAIDS combined w/a disease-modifying antirheumatic drug (DMAR) is the standard of care in patients w/RA.
b. There is no therapeutic difference among NSAIDs, and you may use ibuprofen for any of the rheumatological diseases described. There is no point in waiting to use a DMARD in a patient w/severe RA or anyone w/joint erosions. c. NSAIDs will not delay the progression of disease. |
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20. What is the best initial DMARD (and most widely used)?
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a. Methotrexate. Add others if it is not effective.
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