20 Questions
What is the typical age range for the onset of Rheumatoid Arthritis?
Third to sixth decades of life
Which of the following joints is the most commonly involved in Rheumatoid Arthritis?
Metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the hands
What is the characteristic pathological finding in the joints of patients with Rheumatoid Arthritis?
All of the above
Which of the following is an extra-articular manifestation of Rheumatoid Arthritis?
All of the above
Which of the following is a characteristic clinical feature of Rheumatoid Arthritis?
Morning joint stiffness lasting more than 1 hour, with improvement after physical activity
Which of the following is NOT a common extra-articular manifestation of rheumatoid arthritis?
Osteoarthritis
Which of the following laboratory findings is NOT typically associated with rheumatoid arthritis?
Thrombocytopenia
Which of the following is a characteristic radiographic feature of advanced rheumatoid arthritis?
Joint destruction and collapse
Which of the following is NOT a required criterion for the diagnosis of rheumatoid arthritis according to the 1987 ACR criteria?
Presence of rheumatoid nodules
Which of the following is the most characteristic joint involvement pattern in early rheumatoid arthritis?
Symmetric polyarthritis
What score is needed for the classification of a patient as having definite Rheumatoid Arthritis according to the 2010 ACR/EULAR criteria?
6/10
How many large joints need to be involved to score 2 points in the Joint Involvement category of the 2010 ACR/EULAR criteria?
6-10 large joints
Which of the following serology results would score 3 points in the Serology category of the 2010 ACR/EULAR criteria?
High-positive RF or high-positive ACPA
Which combination of acute-phase reactants results in scoring 1 point in the Acute-phase Reactants category of the 2010 ACR/EULAR criteria?
Abnormal CRP or normal ESR
How long must Criteria 1-4 be present to meet the diagnosis of Rheumatoid Arthritis?
At least 6 weeks
Which of the following joints are NOT involved in Rheumatoid Arthritis?
Sacroiliac joints
Which of the following factors is NOT associated with a higher likelihood of developing extra-articular manifestations in Rheumatoid Arthritis?
Late-onset disease
Which of the following is NOT an extra-articular manifestation of Rheumatoid Arthritis?
Gout
Which of the following laboratory tests is NOT commonly used in the evaluation of Rheumatoid Arthritis?
Anti-double-stranded DNA antibodies
Which of the following is NOT a characteristic feature of Rheumatoid Arthritis?
Acute onset of joint pain and swelling
Study Notes
Rheumatoid Arthritis
- Systemic, autoimmune rheumatic disease affecting approximately 1% of the population.
- Chronic multisystem disease of unknown cause, characterized by persistent inflammatory synovitis leading to cartilage damage, bone erosions, joint deformity, and disability.
Onset
- Most commonly affects people in the third to sixth decades.
- Female: male ratio is 3:1.
- Initial pattern of joint involvement can be polyarticular, oligoarticular, or monoarticular.
- Morning joint stiffness > 1 hour and easing with physical activity is characteristic.
- Small joints of hand and feet are typically involved.
Clinical Manifestations
Articular
- Pain in affected joint aggravated by movement is the most common symptom.
- Morning stiffness ≥1 hour.
- Joints involved:
- MCP and PIP joints of hands (90%)
- MTP of feet (80%)
- Knees, ankles, and wrists (60%)
- Shoulders, elbows, TM, acromio-clavicular, and SC joints (50%)
- Cervical spine ( Instability can lead to impingement of the spinal cord)
Extra-articular
- Present in 30-40% of patients.
- May occur prior to arthritis.
- Patients more likely to get extra-articular manifestations:
- High titres of RF and ACPA
- HLA DR4+
- Male
- Early onset disability
- History of smoking
- Extraarticular manifestations include:
- Constitutional symptoms (most common)
- Rheumatoid nodules (30%)
- Hematological, respiratory, CVS, CNS, eye, and rheumatoid vasculitis
Laboratory Investigations
- CBC: TLC, DLC, Hb, ESR, and GBP
- Acute phase reactants
- Rheumatoid Factor (RF)
- Anti-CCP antibodies (ACPA)
Rheumatoid Factor (RF)
- Antibodies that recognize Fc portion of IgG
- Can be IgM, IgG, or IgA
- 85% of patients with RA over the first 2 years become RF+
ACR Criteria (1987)
-
- Morning Stiffness ≥1 hour
-
- Arthritis of ≥3 joints observed by physician
-
- Arthritis of hand joints
-
- Symmetric arthritis
-
- Rheumatoid nodules
-
- Positive Rheumatoid Factor
-
- Radiographic Erosions or periarticular osteopenia in hand or wrist joints
- Criteria 1-4 must be present for ≥6 weeks
- Must have ≥4 criteria to meet diagnosis of RA
2010 ACR/EULAR Classification Criteria
- Score of ≥6/10 is needed for classification of a patient as having definite RA
- A. Joint involvement SCORE
- 1 large joint
- 2-10 large joints
- 1-3 small joints (with or without involvement of large joints)
- 4-10 small joints (with or without involvement of large joints)
- >10 joints (at least 1 small joint)
- B. Serology (at least 1 test result is needed for classification)
- Negative RF and negative ACPA
- Low-positive RF or low-positive ACPA
- High-positive RF or high-positive ACP
- C. Acute-phase reactants (at least 1 test result is needed for classification)
- Normal CRP and normal ESR
- Abnormal CRP or normal ESR
- D. Duration of symptoms
Test your knowledge on the manifestations of rheumatoid arthritis including extra-articular symptoms, risk factors, and clinical presentations. Learn about the involvement of different joints and common features associated with the disease.
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