Rheumatoid Arthritis Diagnosis and Manifestations

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Which of the following conditions is LEAST likely to be considered in the differential diagnosis of rheumatoid arthritis (RA)?

Carpal tunnel syndrome (correct)
Systemic lupus erythematosus
Osteoarthritis
Fibromyalgia

A patient presents with joint pain, morning stiffness lasting over an hour, and swelling in multiple joints. Which of the following physical exam findings would be MOST indicative of rheumatoid arthritis rather than osteoarthritis?

Limited range of motion in the affected joints
Warmth and tenderness upon palpation of several joints.
Pain that worsens with activity and improves with rest.
Ulnar deviation of the fingers. (correct)

Which of the following is a cardiac manifestation that is MORE likely related to rheumatoid arthritis (RA)?

Myocardial infarction
Pericarditis (correct)
Valvular heart disease
Atrial fibrillation

When comparing rheumatoid arthritis (RA) and osteoarthritis (OA), which statement is MOST accurate?

RA commonly involves systemic symptoms, while OA mainly affects the joints. (A) Signup and view all the answers

A patient with suspected rheumatoid arthritis (RA) reports experiencing stiffness that improves with movement. How should this information be interpreted?

It supports the diagnosis of RA, as RA-related stiffness improves with movement. (C) Signup and view all the answers

In evaluating a patient for possible rheumatoid arthritis (RA), which early physical exam finding would be MOST indicative of the disease?

Swelling of the proximal interphalangeal (PIP) joints (A) Signup and view all the answers

Which of the following extra-articular manifestations is MOST closely associated with rheumatoid arthritis (RA)?

Pleurisy (B) Signup and view all the answers

What is the primary difference between the cause of Rheumatoid Arthritis (RA) and Osteoarthritis (OA)?

RA is caused by an immune system attacking the body, while OA is caused by normal wear and tear. (D) Signup and view all the answers

According to the 1987 classification criteria for rheumatoid arthritis (RA), how long must morning stiffness last to meet the criteria?

At least 1 hour (D) Signup and view all the answers

What is the significance of rheumatoid nodules in the context of rheumatoid arthritis (RA)?

Their presence indicates a more advanced or severe stage of rheumatoid arthritis. (C) Signup and view all the answers

Rheumatoid arthritis is characterized by inflammation of the synovial lining of joints. Which of the following best describes the initial target and early changes in Stage 1 of the disease?

Synovial lining on diarthrodial joints affecting small blood vessels, increased synovial lining production and T-lymphocytes infiltration. (D) Signup and view all the answers

A 45-year-old female presents with stiffness and pain in her wrists and proximal interphalangeal (PIP) joints, which started a few weeks ago. Based on the provided information, what is the MOST likely diagnosis?

Rheumatoid arthritis, affecting small joints such as PIP and wrists. (B) Signup and view all the answers

Which factor is LEAST likely to be a predisposing factor for rheumatoid arthritis?

Diet high in vitamin C. (A) Signup and view all the answers

During the later stages of rheumatoid arthritis progression (Stage 2), pannus formation occurs. What is the MOST significant effect of pannus on the affected joint?

Destruction of cartilage and subchondral bone. (B) Signup and view all the answers

A patient with rheumatoid arthritis develops mononeuritis and skin infarcts. Which of the following extra-articular manifestations is MOST likely responsible for these symptoms?

Vasculitis. (B) Signup and view all the answers

A patient with long-standing rheumatoid arthritis presents with dry eyes and dry mouth. Which extra-articular manifestation is MOST likely causing these symptoms?

Sjogren syndrome. (C) Signup and view all the answers

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

Polyarticular, affecting multiple joints, often including the small joints of the hands and feet. (B) Signup and view all the answers

A patient reports experiencing swelling and pain in her right wrist that lasts for several days, then resolves completely, only to recur in her left ankle a week later. What type of presentation is she MOST likely experiencing?

Palindromic presentation. (B) Signup and view all the answers

Which statement BEST describes the etiology of rheumatoid arthritis?

The etiology is unknown, but genetic and environmental factors are thought to contribute (A) Signup and view all the answers

A patient with rheumatoid arthritis has visible nodules on their elbows. Where else might similar nodules be found due to the systemic nature of the disease?

Cardiac valves, pericardium, pleura, lung parenchyma, or spleen. (A) Signup and view all the answers

A patient presents with joint pain. Which combination of findings would contribute to a classification of Rheumatoid Arthritis (RA) according to the criteria provided?

Low-positive ACPA, abnormal ESR, and symptom duration of greater or equal to 6 weeks. (B) Signup and view all the answers

Why is an ANA (antinuclear antibody) test included in the initial workup for a patient suspected of having rheumatoid arthritis (RA)?

To help differentiate RA from other autoimmune diseases like Systemic Lupus Erythematosus (SLE). (B) Signup and view all the answers

What is the primary purpose of obtaining baseline X-rays of the hands and feet in a patient newly diagnosed with Rheumatoid Arthritis (RA)?

To evaluate the extent of joint space narrowing, erosions, and other structural changes at the time of diagnosis. (A) Signup and view all the answers

Which of the following is LEAST likely to be a reason for performing joint aspiration (fluid analysis) in a patient presenting with possible rheumatoid arthritis?

To confirm the presence of rheumatoid factor in the synovial fluid. (B) Signup and view all the answers

A patient meets the criteria for RA classification and has a symptom duration of greater than 6 weeks. They have elevated CRP, but their rheumatoid factor and ACPA are negative. According to the criteria, what is the minimum needed to classify RA?

Further testing is required to evaluate joint involvement to meet the classification criteria. (C) Signup and view all the answers

A patient presents with pain and swelling in the MCP and PIP joints of both hands. The symptoms have been present for approximately 4 weeks. Which criteria would be the LEAST helpful in determining if the patient has RA?

Order an MRI of the spine. (B) Signup and view all the answers

Which of the following findings would NOT be included in the criteria for diagnosing rheumatoid arthritis?

Elevated levels of anti-double stranded DNA (anti-dsDNA). (A) Signup and view all the answers

A patient with suspected RA has normal CRP and ESR values. How does this affect their classification according to the criteria?

It reduces the likelihood of RA but does not eliminate it, as other criteria can still contribute to the overall score. (A) Signup and view all the answers

A patient has a low-positive RF and a normal CRP. They have had symptoms for 7 weeks. What information is needed to classify the patient as having RA?

The number of involved joints. (E) Signup and view all the answers

Which of the following conditions should be screened for in patients with Rheumatoid Arthritis, but is NOT directly related to the joint inflammation or autoimmune process of RA itself?

Latent Tuberculosis (TB). (A) Signup and view all the answers

Which of the following best describes the etiology of rheumatoid arthritis?

Largely attributed to genetic predisposing factors, environmental influences, hormonal factors and reproduction. (B) Signup and view all the answers

In the early stage of rheumatoid arthritis, which of the following is the primary target structure?

The synovial lining of diarthrodial joints (wrist, elbow, hip & knee). (B) Signup and view all the answers

What is the role of 'pannus' formation in the progression of rheumatoid arthritis?

It destroys cartilage and subchondral bone, further damaging the joint. (B) Signup and view all the answers

A patient presents with painful articulation and tenderness in several joints, with the symptoms initially appearing in one or two joints before spreading. This pattern is MOST indicative of what?

Palindromic presentation of rheumatoid arthritis. (C) Signup and view all the answers

Which joints are typically involved in rheumatoid arthritis?

Proximal interphalangeal (PIP) and metacarpophalangeal (MCP) of hands, wrists and small joints of feet include metatarsophalangeal (MTP). (D) Signup and view all the answers

What are subcutaneous nodules in rheumatoid arthritis typically associated with?

Areas of trauma or pressure. (A) Signup and view all the answers

Besides joint involvement, what other organ systems can be affected by rheumatoid nodules?

Cardiac valves, pericardium, pleura, lung parenchyma, & spleen. (D) Signup and view all the answers

Which of the following extra-articular manifestations is related to blood vessel inflammation in rheumatoid arthritis?

Vasculitis. (A) Signup and view all the answers

How does rheumatoid arthritis typically affect women compared to men?

Women are affected 2 to 3 times more than men. (B) Signup and view all the answers

Which of the following is an ocular manifestation associated with rheumatoid arthritis?

Sjogren syndrome, episcleritis, & scleritis. (D) Signup and view all the answers

A patient presents with pain in their wrists and MCP joints. Which of the following findings would contribute to classification of rheumatoid arthritis (RA) according to the criteria?

Symmetric involvement of PIP joints, plus a high-positive anti-CCP. (B) Signup and view all the answers

A patient has suspected rheumatoid arthritis. Their rheumatoid factor (RF) test comes back negative, but their anti-CCP (cyclic citrullinated peptide) antibody test is highly positive. According to the classification criteria, how many points do they score for serology?

3 points (A) Signup and view all the answers

Which of the following is LEAST likely to be part of the initial workup for a patient suspected of having rheumatoid arthritis (RA)?

MRI to identify presence of melanoma (D) Signup and view all the answers

A patient's X-ray shows early erosive changes in the joints of their hands. According to the criteria, this finding primarily falls under which category?

Arthritis of hand joints. (A) Signup and view all the answers

Which of the following imaging techniques is MOST sensitive for detecting early subclinical synovitis in a patient with suspected rheumatoid arthritis?

MRI. (D) Signup and view all the answers

A patient meets the criteria for RA and requires screening, which of the following is needed?

Screening for latent TB. (C) Signup and view all the answers

A patient presents with joint pain. Which of the following components is necessary to classify a patient with RA?

Symptoms must be present for at least 6 weeks (A) Signup and view all the answers

Which test is the MOST useful to rule out SLE?

ANA (B) Signup and view all the answers

A patient has low-positive RF, which would indicate how many points based on serology?

2 (A) Signup and view all the answers

What is needed to classify RA?

A score >= 6/10 (D) Signup and view all the answers

Which of the following physical exam findings would be LEAST consistent with early-stage rheumatoid arthritis?

Joint pain worsening with movement and improving with rest (D) Signup and view all the answers

A patient presents with suspected rheumatoid arthritis. Which of the following findings would most strongly suggest rheumatoid arthritis rather than osteoarthritis?

Systemic symptoms such as fatigue and low-grade fever (D) Signup and view all the answers

Which of the following is a late-stage manifestation commonly observed in patients with rheumatoid arthritis affecting the hands?

Ulnar deviation of the fingers (B) Signup and view all the answers

A patient is being evaluated for joint pain. Which historical finding would be most concerning for rheumatoid arthritis?

Morning stiffness lasting for several hours (A) Signup and view all the answers

Which of the following conditions is least likely to be included in the differential diagnosis of rheumatoid arthritis?

Pleurisy (D) Signup and view all the answers

Which of the following exam findings is most indicative of active inflammation in a joint affected by rheumatoid arthritis?

Warmth and erythema of the overlying skin (A) Signup and view all the answers

A patient with rheumatoid arthritis reports new onset of shortness of breath and chest pain. Which of the following conditions might be the cause?

Valvular heart disease (C) Signup and view all the answers

Which of the following features helps differentiate rheumatoid arthritis (RA) from osteoarthritis (OA)?

RA commonly presents with systemic symptoms, while OA is typically localized (D) Signup and view all the answers

In the context of rheumatoid arthritis, what does the term 'boggy' describe when used to assess an affected joint?

The thickness of the synovial membrane (D) Signup and view all the answers

A 50-year-old patient presents with joint pain. Which of the following, if present, would point away from a diagnosis of osteoarthritis and toward rheumatoid arthritis?

Elevated inflammatory markers on laboratory testing (D) Signup and view all the answers

Which of the following BEST describes the underlying cause of rheumatoid arthritis?

An autoimmune reaction targeting the body's own joint tissues. (C) Signup and view all the answers

Which statement BEST reflects the typical progression of joint involvement in rheumatoid arthritis?

RA generally presents symmetrically, affecting the same joints on both sides of the body. (D) Signup and view all the answers

In the early stages of rheumatoid arthritis, what is the PRIMARY target within the joint?

The synovial membrane lining the joint capsule. (A) Signup and view all the answers

What is the MOST significant consequence of pannus formation in rheumatoid arthritis?

Erosion of cartilage and underlying bone. (B) Signup and view all the answers

A patient with rheumatoid arthritis develops inflammation of the blood vessels, leading to nerve damage and skin ulcerations. Which extra-articular manifestation is MOST likely responsible?

Vasculitis (B) Signup and view all the answers

A patient with RA presents with new-onset foot pain. Which joints are MOST likely to be affected?

Metatarsophalangeal (MTP) (B) Signup and view all the answers

What is the significance of HLA-DRB1 alleles in the context of rheumatoid arthritis?

They are genetic factors that predispose individuals to developing RA. (D) Signup and view all the answers

A patient experiences recurrent episodes of joint swelling and pain that resolve completely, only to reappear in different joints later. How is this pattern of presentation BEST described?

Palindromic (D) Signup and view all the answers

Which of the following is most closely associated with subcutaneous rheumatoid nodules?

They frequently develop in areas of pressure, particularly at the elbows. (C) Signup and view all the answers

A 35-year-old woman presents with pain and stiffness in her wrists and small joints of her hands. She also reports significant fatigue. Which of the following would be MOST helpful in supporting a diagnosis of rheumatoid arthritis?

Positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. (C) Signup and view all the answers

A patient presents with symptoms suggestive of rheumatoid arthritis. Which of the following findings would be MOST indicative of an early stage of the disease?

Swelling of the proximal interphalangeal (PIP) joints (A) Signup and view all the answers

A patient with suspected rheumatoid arthritis reports that their joint stiffness is most pronounced in the morning and lasts for several hours. How does this information contribute to the diagnosis?

It is consistent with RA, as morning stiffness lasting longer than one hour is a common criterion. (A) Signup and view all the answers

A patient presents with joint pain and swelling. Which of the following physical exam findings would be MOST indicative of rheumatoid arthritis rather than osteoarthritis?

Warmth and erythema around the affected joints. (C) Signup and view all the answers

Which of the following extra-articular manifestations is MOST suggestive of rheumatoid arthritis?

Pericarditis. (D) Signup and view all the answers

A 50-year-old female presents with pain, swelling, and stiffness in her hands and wrists. Physical examination reveals synovitis in multiple joints. Which of the following historical features would be MOST suggestive of rheumatoid arthritis?

Morning stiffness lasting longer than one hour. (C) Signup and view all the answers

When evaluating a patient for possible rheumatoid arthritis, what would be the significance of observing ulnar deviation and swan neck deformities?

These are late-stage manifestations of RA suggesting significant joint damage. (C) Signup and view all the answers

Which of the following best describes the role of the synovial membrane in the pathogenesis of rheumatoid arthritis?

The synovial membrane thickens and becomes inflamed, leading to pannus formation and joint destruction. (A) Signup and view all the answers

A patient with rheumatoid arthritis develops interstitial lung disease. Which of the following is the MOST likely presenting symptom related to this extra-articular manifestation?

Progressive shortness of breath and dry cough. (C) Signup and view all the answers

A patient is being evaluated for rheumatoid arthritis. Which combination of clinical findings would MOST strongly support a diagnosis of RA according to the classification criteria?

Morning stiffness lasting 60 minutes, arthritis in four joints, elevated ESR. (D) Signup and view all the answers

A patient with RA is experiencing numbness and tingling in their hands. Which of the following conditions associated with RA is MOST likely causing these symptoms?

Carpal tunnel syndrome (D) Signup and view all the answers

A patient presents with pain and swelling in the MCP and PIP joints of both hands. Symptoms have been present for approximately 5 weeks. Which of the following criteria would be MOST helpful in assessing if the patient should be classified as having RA?

Duration of symptoms being at least 6 weeks. (C) Signup and view all the answers

According to the classification criteria for rheumatoid arthritis, which combination of test results would yield the HIGHEST score for the 'serology' domain?

High-positive rheumatoid factor (RF) and high-positive anti-CCP antibody (ACPA). (C) Signup and view all the answers

What is the diagnostic criteria cut off needed to classify RA?

A score >= 6/10 (A) Signup and view all the answers

In a patient with suspected rheumatoid arthritis, which imaging modality is MOST capable of detecting early erosive changes and subclinical synovitis?

MRI (D) Signup and view all the answers

A patient presenting with joint pain is suspected of having rheumatoid arthritis. The acute phase reactants are being evaluated. Which test result is MOST indicative of rheumatoid arthritis?

Abnormal C-reactive protein (CRP) and abnormal erythrocyte sedimentation rate (ESR). (D) Signup and view all the answers

A patient presents with suspected RA but has normal CRP and ESR. They have had symptoms for 7 weeks. What serological findings would classify the patient as having RA?

High-positive RF or high-positive ACPA and arthritis of at least 1 small joint (C) Signup and view all the answers

When performing joint aspiration on a patient with possible rheumatoid arthritis, what conditions can be ruled out?

Gout, pseudogout, and septic arthritis. (D) Signup and view all the answers

In the context of diagnosing rheumatoid arthritis, why is a baseline X-ray of the hands and feet performed?

To assess the severity of existing joint damage and monitor disease progression. (A) Signup and view all the answers

Aside from autoimmune markers and acute-phase reactants, which other tests should be performed in the initial work up?

Chemistry panel, complete blood count (D) Signup and view all the answers

Why is screening for latent tuberculosis (TB) recommended in patients diagnosed with rheumatoid arthritis?

To identify and treat latent TB before initiating immunosuppressive therapies for RA. (C) Signup and view all the answers

Arthritis of hand joints

One or more swollen areas in the wrist, MCP, or PIP joint.

Symmetric arthritis

Simultaneous involvement of the same joint areas on both sides of the body.

Serum RF

Elevated rheumatoid factor measured by any method in which positive results are found in 10 joints (at least 1 small joint).