RA

Question 1

Symptoms

Answer 1

Insidious onset of morning stiffness and polyarthropathy

Usually affects hand and feet

 - DIP joint of hand is usually spared
 - May also affect knees, cervical spine, ankle   and shoulder

Question 2

Physical exam

Answer 2

1. Subcutaneous nodules in 20% (strong association with positive serum RF)
2. Ulnar deviation with MCP subluxation, swan neck deformity
3. Hallux valgus, claw toes, MTP subluxation
4. Joints become affected at later stage in disease process

Question 3

X-rays

Answer 3

1. Periarticular erosions and osteopenia
2. Protrusio acetabuli
   - medial migration of femoral head past the radiographic teardrop
3. Joint space narrowing
4. Central glenoid erosion

Question 4

Labs

Answer 4

• anti-CCP (cyclic citrullinated peptide, most sensitive and specific)
• anti-MCV (mutated citrullinated vimentin)
• elevated ESR
• elevated CRP
• positive RF titer (most commonly IgM)
  - targets the Fc portion of IgG
  - elevated in 75-80%
• joint fluid testing
  - decreased complement
  - May have elevated RF levels

Question 5

Diagnostic criteria

1987 revised criteria for diagnosis of RA

Answer 5

Have 4 or more out of the 7 criteria for a 6 week period

1. Morning stiffness equal to or greater than 1hr
2. Swelling kn 3 or more joints
3. Rheumatoid nodules
4. Radiographic changes of the hand incl bony erosions and decalcification
5. Symmetric arthritis
6. Serum rheumatoid factor
7. Arthritis of the hand (MCP, PIP) and wrist