Which deformity is characterised by MCP flexion, PIP hyperextension and DIP flexion?
Swan neck deformity
Which human leucocyte antigen (HLA) gene is associated with rheumatoid arthritis?
HLA-DRB1
What produces rheumatoid factor antibodies and anticitrullinated protein antibodies and where are they produced?
They are produced by activated B-cells in the synovium
What joints are affected by rheumatoid arthritis?
- shoulders
- elbows
- wrist
- MCP joints
- PIP joints
- knees
- ankles
- MTP joint
What is the Norfolk Arthritis Register?
A primary care based inception cohort of patients with inflammatory arthritis
What is the classification criteria for RA?
At least 4 of the following for 6 weeks:
- Morning stiffness > 1 hour
- Arthritis of > 3 joint areas
- Symmetry
- Nodules
Radiographic erosions - Rheumatoid factor positive
How does synovitis present upon examination?
- “boggy” joint swelling (similar consistency to a grape)
- the skin is usually warm and red (due to increased blood flow)
- swelling is tender to palpate
What are Boutonniere and swan-neck deformities of the digits due to?
PIP synovitis and laxity and/or contraction of the extensor and flexor tendons
What are the 4 main radiological signs of rheumatoid arthritis?
- soft tissue swelling
- periarticular osteoporosis
- juxta-articular erosions
- narrowing of joint space
Name 3 categories assessed by the HAQ disability index
- dressing and grooming
- reach and grip
- walking
What is the pathological process behind synovitis in rheumatoid arthritis?
- inflammatory cells infiltrate the synovium and proliferate
- macrophages and osteoclasts create a layer of chronically inflamed tissue (pannus) which extends from the joint margins and erodes the articular cartilage
True or false?
Rheumatoid arthritis affects men more than it affects women?
False
woman > men
2:1
What are ligament insertions (entheses) a common site of in RA?
inflammation
Which deformity is this?
Swan neck
Which deformity is characterised by PIP flexion with DIP hyperextension?
Boutonniere
True or false?
rheumatoid arthritis of the ankles are included in the DAS-28 score
False
How can immunisation cause RA in some patients?
the patient has an abnormal immune system and the immunisation has acted as a trigger
What are 4 extraarticular features of RA?
- rheumatoid nodules
- tenosynovitis
- bursitis
- carpal tunnel syndrome
Which deformity is this?
Boutonniere
Describe the Health Assessment Questionnaire (HAQ)
Total score can range from 0-3.0
higher scores indicate worse function
and greater disability
What are 4 systemic complications of RA?
- feeling systemically unwell
- anaemia
- felty syndrome
- rheumatoid lung disease
What is the societal impact of RA?
- within 3 years of diagnosis, 25% of patients are no longer working
- personal loss of income
- government loss of taxation
- drug costs
What are 3 predictors of a poor prognosis?
- RF/Anti-CCP
- Nodules
- HAQ score
The DAS-28 (disease activity score) is a statistically derived index using:
- Tender joint score
- Swollen joint score
- ESR
- General health assessment
