Rheumatoid arthritis

1. How does synovial fluid present like in RA?Cloudy fluid, elevated WBC’s
2. How would you describe Swan Neck deformities?Extended PIPJ, Flexed DPIJ
3. What damage in RA causes fibular deviation of the digits?Medial plantar met head erosive changes —> medial collateral ligament weakens —> lateral deviation
4. What will be increased in RA?RF+, WBC, ESR, CRP
5. Late-stage finding of RAsymmetric joint space narrowing
6. Gold standard for diagnosis of RA?Gadolinium contrast
7. What is manifested as the following triad: RA, neutropenia, splenomegalyFelty’s Syndrome
8. What is a radiographic finding which could be seen in RA or psoriatic arthritis?Arthritis Mutilans, aka “pencil in cup”
9. What is a genetic risk factor for RA?HLA-DR4
10. Clinical finding of RA in the nails?Splinter hemorrhages
11. What causes destruction of articular cartilage in RA?chondrolytic enzymes from pannus
12. What types of arthritis are HLA-B27(+)?a. Psoriatic arthritis
b. Reiter Syndrome
c. Ankylosing Spondylitis
13. Why are patients with RA more likely to have a slow wound healing time?The medications used to treat RA (corticosteroids, DMARD’s, anti-TNFα) impact the inflammatory phase of wound healing
14. Why are NSAIDs used for the treatment of RA?Decrease inflammation at the joint
15. What do NSAIDs inhibit?COX-1 and COX-2 pathways
16. What will happen if an NSAID is given alongside Probenecid?Higher concentration of NSAID
17. What is happening to the joint in patients with RA?the immune system is attacking the joint —> inflammation —> joint capsule thickening
18. Dermatological clinical finding often seen at the joints in RARheumatoid nodules
19. Name 1 type of surgical intervention for a patient RA with symptomatic tarsus or anklea. Synovectomy
b. Arthroplasty
c. Arthrodesis
20. What will happen if an NSAID is given alongside methotrexate?Methotrexate will have a lower clearance rate
21.What will happen if an NSAID is given alongside a corticosteroid?Higher chance of gastrointestinal bleeding and perforation
22. What will happen if a NSAID is given alongside lithium?Lithium will have a lower clearance rate
23. Hematologic-related finding in patients with RA?Anemia
24. What is the mechanism of action for methotrexate?Inhibits dihydrofolate reductase —> impaired DNA synthesis —> reduce IL-1 production
25. What are some conservative treatments that could be offered to a RA patient?Icing, NSAIDs, orthotics, lace-up brace (hindfoot, ankle pain), steroid injection
26. Where is a Baker’s cyst typically found?Popliteal fossa
27. What type of arthritis is seen with “bamboo spine”?Ankylosing spondylitis
28. What type of arthritis is associated with myxoid cysts?osteoarthritis
29. A patient has a red, hot, swollen right 1st MTPJ. Has a Martel’s sign on imaging? Dx?gout
30. What’s the difference between metabolic gout vs renal gout?a. Over producer of uric acid (metabolic); under producer (renal)