Rheumatoid Arthritis Diagnosis

Questions and Answers

What is the typical pattern of joint involvement in rheumatoid arthritis?

Symmetric inflammatory polyarthritis involving more than 3 joints (correct)

Symmetric inflammatory polyarthritis involving less than 3 joints

Asymmetric polyarthritis with predominant involvement of DIP joints

Asymmetric inflammatory polyarthritis

Which of the following symptoms is a characteristic feature of affected joints in rheumatoid arthritis?

Pain localized solely to the DIP joints

Morning pain and/or stiffness lasting over 60 minutes (correct)

Acute, sudden onset of joint pain

Pain that worsens with joint movement

What defines the 'gelling phenomenon' in rheumatoid arthritis?

Improvement of symptoms with prolonged inactivity

Worsening of symptoms with prolonged inactivity (correct)

Joint pain that worsens with movement

Joint pain that improves with rest

Which hand deformity is NOT typically associated with rheumatoid arthritis?

Bouchard's nodes Signup and view all the answers

What is a significant risk associated with cervical spine involvement in chronic rheumatoid arthritis?

C1-C2 subluxation Signup and view all the answers

Which joints are typically spared in rheumatoid arthritis?

DIP joints Signup and view all the answers

For management, which aspect is critical when assessing disease activity in rheumatoid arthritis?

Erythema and warmth in joints Signup and view all the answers

Which laboratory test is most informative in confirming a diagnosis of rheumatoid arthritis?

Rheumatoid factor (RF) Signup and view all the answers

Which type of therapy is commonly utilized in the treatment of rheumatoid arthritis?

DMARD therapy Signup and view all the answers

What is considered an atypical presentation of rheumatoid arthritis that can complicate diagnosis?

Unilateral joint involvement Signup and view all the answers

Study Notes

Differential Diagnosis

Rheumatoid Arthritis (RA) must be distinguished from symmetrical seronegative spondyloarthropathies.
Severe RA can resemble a type of psoriatic arthritis known as "arthritis mutilans."

Diagnosis Criteria

A positive serology is now a requirement for RA diagnosis.
Joint involvement scoring:
- 1 large joint: 1 point
- 2-10 large joints: 2 points
- 1-3 small joints: 1 point
- 4-10 small joints: 2 points

Radiological Findings

Classic radiographic signs include:
- Periarticular osteopenia
- Joint space narrowing
- Juxtaarticular erosions
- Erosions of the ulnar styloids
Early signs often first seen in the feet, particularly at the fifth metatarsophalangeal joint.

Laboratory Tests

Rheumatoid Factor (RF):
- Antibodies targeting the Fc region of IgG; poor specificity for RA.
- Associated conditions: SLE, Sjögren's syndrome, viral infections (HCV, EBV, etc.).
- Only about 50% of RA patients are RF positive at onset; up to 20% may remain negative.
- High titers can indicate an aggressive disease course.
Anti-Cyclic Citrullinated Peptide (anti-CCP):
- More specific for RA (90%-95%) but less sensitive than RF.
- Positive results suggest increased risk for radiographic progression.
Serum markers:
- Elevated ESR and CRP, though not sensitive or specific for RA.
- Common occurrence of anemia of chronic disease.
- Normal or increased platelet count, contrasting with low counts in SLE.
- Synovial fluid analysis shows sterility with a high neutrophil count in uncomplicated cases.

Management Strategies

Assess disease activity using history, physical examination, and standardized Disease Activity Score.
Treatment based on disease severity:
- Low activity: Initiate DMARD monotherapy.
- High activity: Consider combination DMARD therapy or anti-TNF therapy.
Early initiation of DMARDs is critical to reduce damage and disability.
During pregnancy, prednisone and hydroxychloroquine are recommended anti-inflammatory agents.

Clinical Features

Articular Manifestations:
- Symmetric inflammatory polyarthritis involving more than three joints, typically affecting:
  - MCP, PIP, wrist, elbow, knee, ankle, MTP joints.
- Characteristic symptoms include:
  - Morning pain or stiffness lasting more than 60 minutes for at least six weeks.
  - Symptoms improve with movement but worsen with inactivity (Gelling phenomenon).
  - Presence of erythema, warmth, or swelling in joints.
  - Notable hand deformities include ulnar deviation at MCPs, swan neck, and boutonniere deformities.
Spinal Involvement:
- RA may affect the cervical spine, with risk of asymptomatic C1-C2 (atlanto-axial) subluxation.
- Important to perform cervical spine x-ray before tracheal intubation to evaluate for potential complications.

Description

This quiz covers the diagnostic criteria for Rheumatoid Arthritis (RA), including the distinction from symmetrical seronegative spondyloarthropathies and related conditions. Test your knowledge on the diagnostic criteria and points associated with joint involvement and serology requirements.