RA Exam

Question 1

Hx 1- FAGI

Answer 1

• Familial history: Increased frequency among first degree relatives
• Age: Usually begins in 3-4th decade (peak onset) (usually occurs in people between 25-55)
• Gender- Female (1.6) : male (1)
• Insidious Onset of:
• fatigue
• LoW
• low-grade fever
• malaise
  morning stiffness >1 hour
• weakness
• widespread myalgia

Question 2

Early Articular Manifestations

Answer 2

• Joint pain (due to inflammation, >2-3Jts)
• Joint & Periarticular Tissue swelling (spindle/diamond shaped joints; swollen and puffy to the touch)
• Joint is warm, red and tender to palpation
• Joint involvement is symmetric (Wrists, fingers, knees, feet, and ankles are the most commonly affected)
• MCP, PIP joints of fingers & toes are typically affected
• Decreased ROM in affected joints; capsular pattern present in affected joints
• Joint stiffness or gelling
  occurs after inactivity e.g. morning stiffness lasts > 60 min

Question 3

Established Articular Manifestations

Answer 3

• Increase in Jts affected

Wrists (most frequent) 
Feet
Knees
Shoulders
Cx spine 

• Tenosynovitis, commonly affecting

Wrist extensors
Digit flexor sheaths
Obs. Tenderness of tendons
Obs. crepitation of finger movement

• Bursitis
• Bakers Cyst

Question 4

Advanced Articular Manifestations

Answer 4

• Constant Ache -> progressive Jt destruction
• Joint deformity (d/t instability & tendon rupture)

ulnar deviation of fingers
radial and palmar deviation of wrists
valgus knees
valgus feet

• Severely limited ROM in affected joints

Question 5

Extra Articular Manifestations

Answer 5

• Rheumatoid Nodules (round painless, subcutaneous)
• Vasculitis (rashes, capillary dilation)
• Mm wasting
• lymphadenopathy
• splenomegally
• pleuritis
• Pericarditis
• scleritis / uveitis -> visual disturbances
• pallor d/t anaemia
• neuropathy (tingling, numbness)

Question 6

Classification

Answer 6

• EULAR Table
• 4 Criteria
  Joint
  Serology
  Acute-Phase
  Duration
• Score of >6 = RA