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Questions and Answers
Which of the following radiologic features indicates an advanced lesion in rheumatoid arthritis?
Which of the following radiologic features indicates an advanced lesion in rheumatoid arthritis?
What is the primary characteristic of the pathogenesis of pannus formation in rheumatoid arthritis?
What is the primary characteristic of the pathogenesis of pannus formation in rheumatoid arthritis?
Which physical examination finding is commonly associated with advanced rheumatoid arthritis?
Which physical examination finding is commonly associated with advanced rheumatoid arthritis?
Which systemic effect is associated with inflammation in rheumatoid arthritis?
Which systemic effect is associated with inflammation in rheumatoid arthritis?
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Which of the following x-ray findings is indicative of joint erosion in rheumatoid arthritis?
Which of the following x-ray findings is indicative of joint erosion in rheumatoid arthritis?
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What is a characteristic deformity associated with advanced rheumatoid arthritis?
What is a characteristic deformity associated with advanced rheumatoid arthritis?
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What symptom may indicate an extension of inflammation to nearby bone in a patient with rheumatoid arthritis?
What symptom may indicate an extension of inflammation to nearby bone in a patient with rheumatoid arthritis?
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Which of the following symptoms suggests a significant systemic effect of rheumatoid arthritis?
Which of the following symptoms suggests a significant systemic effect of rheumatoid arthritis?
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What is the primary antibody type associated with rheumatoid factor?
What is the primary antibody type associated with rheumatoid factor?
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Which of the following is considered an extra-articular lesion associated with rheumatoid arthritis?
Which of the following is considered an extra-articular lesion associated with rheumatoid arthritis?
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What pathological change is primarily responsible for joint erosion in rheumatoid arthritis?
What pathological change is primarily responsible for joint erosion in rheumatoid arthritis?
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Which immune cells are primarily activated in the pathophysiology of rheumatoid arthritis?
Which immune cells are primarily activated in the pathophysiology of rheumatoid arthritis?
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Smoking is considered which type of factor in the development of rheumatoid arthritis?
Smoking is considered which type of factor in the development of rheumatoid arthritis?
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What role do plasma cells play in rheumatoid arthritis?
What role do plasma cells play in rheumatoid arthritis?
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Which of the following is NOT typically associated with the pathophysiology of rheumatoid arthritis?
Which of the following is NOT typically associated with the pathophysiology of rheumatoid arthritis?
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What is the primary mechanism leading to the erosion of bone in rheumatoid arthritis?
What is the primary mechanism leading to the erosion of bone in rheumatoid arthritis?
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What is a key characteristic of chronic gouty arthritis?
What is a key characteristic of chronic gouty arthritis?
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Which locations are most commonly involved with tophi deposits?
Which locations are most commonly involved with tophi deposits?
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What serum urate level indicates the beginning of crystal precipitation?
What serum urate level indicates the beginning of crystal precipitation?
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Which radiographic hallmark is NOT typically seen in chronic gout?
Which radiographic hallmark is NOT typically seen in chronic gout?
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What condition is characterized by soft tissue swelling, juxta-articular erosive changes, and preserved joint space?
What condition is characterized by soft tissue swelling, juxta-articular erosive changes, and preserved joint space?
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What imaging findings are characteristic of gout?
What imaging findings are characteristic of gout?
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Which statement about the relationship between repeated attacks of gout and crystal presence is true?
Which statement about the relationship between repeated attacks of gout and crystal presence is true?
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In a patient with gout, which feature would you expect to find in a plain X-ray of an affected joint?
In a patient with gout, which feature would you expect to find in a plain X-ray of an affected joint?
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What is a primary consequence of arteriolar vasodilatation during acute inflammation?
What is a primary consequence of arteriolar vasodilatation during acute inflammation?
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Which chemical mediators are involved in the immediate increase of vascular permeability?
Which chemical mediators are involved in the immediate increase of vascular permeability?
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What occurs during the process of leukocyte transmigration?
What occurs during the process of leukocyte transmigration?
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What is the role of leukocytes in the inflammatory response?
What is the role of leukocytes in the inflammatory response?
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Which of the following is a feature of increased vascular permeability?
Which of the following is a feature of increased vascular permeability?
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What is the most important function of the inflammatory response?
What is the most important function of the inflammatory response?
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What is a characteristic microscopic feature of blood vessels during acute inflammation?
What is a characteristic microscopic feature of blood vessels during acute inflammation?
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Which of the following describes delayed increased vascular permeability mechanisms?
Which of the following describes delayed increased vascular permeability mechanisms?
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What is a key microscopic feature of rheumatoid arthritis?
What is a key microscopic feature of rheumatoid arthritis?
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Which joints are typically affected first in rheumatoid arthritis?
Which joints are typically affected first in rheumatoid arthritis?
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What is a common clinical symptom of rheumatoid arthritis?
What is a common clinical symptom of rheumatoid arthritis?
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Which of the following features is associated with rheumatoid arthritis
Which of the following features is associated with rheumatoid arthritis
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What is the characteristic feature of a Boutonniere deformity?
What is the characteristic feature of a Boutonniere deformity?
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Which of the following does rheumatoid arthritis NOT typically affect?
Which of the following does rheumatoid arthritis NOT typically affect?
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Which systemic symptoms are commonly seen in rheumatoid arthritis?
Which systemic symptoms are commonly seen in rheumatoid arthritis?
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What is the link between rheumatoid arthritis and cardiovascular health?
What is the link between rheumatoid arthritis and cardiovascular health?
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Study Notes
Rheumatoid Arthritis
- Advanced changes of rheumatoid arthritis include widespread joint space loss, periarticular erosions, osteopenia, ulnar deviation, swan neck, and boutonniere deformities.
- The pathogenesis of pannus formation in rheumatoid arthritis is chronic inflammation of the synovium.
- The red hot joint is a symptom of acute inflammation that can resolve, lead to suppuration and severe damage, or extend to the bone causing osteomyelitis.
- Systemic effects of the red hot joint include fever, malaise, anorexia, nausea, lympho-reticular hyperplasia, raised ESR, and raised WCC.
Gout
- Serum urate levels of approximately 6.8 mg/dl are the concentration at which crystals begin to precipitate.
- Gouty arthritis radiographic features include classic marginal erosions, overhanging cortex, preservation of bone density, and maintenance of the joint space.
Rheumatoid Factor
- High levels of rheumatoid factor in the blood are often associated with autoimmune diseases like Rheumatoid arthritis.
- Rheumatoid factor is IgM directed to the altered Fc fragment of IgG.
Pathological lesions of Rheumatoid Arthritis
- Articular lesions include synovial inflammation (pannus), destruction of articular cartilage, erosion of adjacent bone, and fibrous fusion (ankylosis).
- Extra-articular lesions include rheumatoid nodules and vasculitis.
Pathophysiology of Rheumatoid Arthritis
- Environmental factors like smoking and bacteria play a part in the development of rheumatoid arthritis.
- Genetic factors in individuals can lead to modification of autoantigens which trigger an immune response and contribute to the development of rheumatoid arthritis.
- T-lymphocytes hone to the joints and activate macrophages.
- Macrophages break down cartilage and bone.
- Macrophages and T-lymphocytes produce cytokines and enzymes that lead to the destruction of cartilage and bone.
- Bone erosion in rheumatoid arthritis involves pannus formation and ankylosis.
Clinical features of Rheumatoid Arthritis
- Systemic symptoms like low grade fever, weakness, malaise, and weight loss can be observed.
- Joint pain, warmth, swelling, morning stiffness, and joint deformity characteristically occur.
- Rheumatoid nodules can appear on the skin.
- Positive rheumatoid factor and anti-CCP antibodies are often found.
- An increased risk of cardiovascular disease is linked to inflammatory vasculitis.
- Small joints of the hand (metacarpophalangeal, proximal interphalangeal joints of hands and feet), wrists, elbows, and knees are commonly affected.
- Gross features include pannus (fibrovascular tissue or granulation tissue), irregular surface from synovial hyperplasia, and subchondral cysts.
- Boutoniere and Swan neck deformities can occur.
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Description
This quiz covers advanced concepts in rheumatoid arthritis, including pathogenesis, symptoms, and systemic effects. It also explores the clinical features of gout and the significance of serum urate levels. Test your knowledge on these two important forms of arthritis.
