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What is the primary site of pathology in rheumatoid arthritis?
What is the primary site of pathology in rheumatoid arthritis?
Which autoantibody is commonly associated with rheumatoid arthritis?
Which autoantibody is commonly associated with rheumatoid arthritis?
What demographic shows a higher prevalence of rheumatoid arthritis?
What demographic shows a higher prevalence of rheumatoid arthritis?
Which factor is believed to contribute to the initiation of clinical disease in rheumatoid arthritis?
Which factor is believed to contribute to the initiation of clinical disease in rheumatoid arthritis?
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What is the typical age range for the onset of rheumatoid arthritis in women?
What is the typical age range for the onset of rheumatoid arthritis in women?
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What is a common pattern of onset for most patients with rheumatoid arthritis?
What is a common pattern of onset for most patients with rheumatoid arthritis?
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Which of the following exposures is considered an environmental factor linked to rheumatoid arthritis?
Which of the following exposures is considered an environmental factor linked to rheumatoid arthritis?
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What percentage of adults are affected by rheumatoid arthritis?
What percentage of adults are affected by rheumatoid arthritis?
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Which virus is identified as a potential environmental factor in the etiology of rheumatoid arthritis?
Which virus is identified as a potential environmental factor in the etiology of rheumatoid arthritis?
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What is the mean concordance rate of rheumatoid arthritis in monozygotic twins?
What is the mean concordance rate of rheumatoid arthritis in monozygotic twins?
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Which tests are primarily used to establish the diagnosis of rheumatoid arthritis?
Which tests are primarily used to establish the diagnosis of rheumatoid arthritis?
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Which of the following is NOT a component of the ABCDE'S mnemonic for radiographic features of rheumatoid arthritis?
Which of the following is NOT a component of the ABCDE'S mnemonic for radiographic features of rheumatoid arthritis?
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What is the significance of rheumatoid factor and anti-citrullinated peptide antibodies in rheumatoid arthritis?
What is the significance of rheumatoid factor and anti-citrullinated peptide antibodies in rheumatoid arthritis?
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Which complication is commonly seen in patients with longstanding, poorly controlled rheumatoid arthritis?
Which complication is commonly seen in patients with longstanding, poorly controlled rheumatoid arthritis?
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Which of the following factors are associated with a poor prognosis in rheumatoid arthritis?
Which of the following factors are associated with a poor prognosis in rheumatoid arthritis?
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Which joint feature is characterized by 'swan neck' and 'ulnar deviation' deformities in rheumatoid arthritis?
Which joint feature is characterized by 'swan neck' and 'ulnar deviation' deformities in rheumatoid arthritis?
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What is the primary goal in the treatment of rheumatoid arthritis?
What is the primary goal in the treatment of rheumatoid arthritis?
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Which of the following is a common neurological complication in rheumatoid arthritis?
Which of the following is a common neurological complication in rheumatoid arthritis?
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Which imaging technique is primarily used to monitor disease damage in rheumatoid arthritis?
Which imaging technique is primarily used to monitor disease damage in rheumatoid arthritis?
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In rheumatoid arthritis, what happens to joint cartilage in weight-bearing joints according to the ABCDE'S features?
In rheumatoid arthritis, what happens to joint cartilage in weight-bearing joints according to the ABCDE'S features?
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What is the hallmark feature of rheumatoid arthritis (RA)?
What is the hallmark feature of rheumatoid arthritis (RA)?
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In which demographic is insidious onset of RA most commonly observed?
In which demographic is insidious onset of RA most commonly observed?
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What percentage of patients with RA are likely to have cervical spine involvement?
What percentage of patients with RA are likely to have cervical spine involvement?
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Which symptoms are commonly associated with rheumatoid arthritis?
Which symptoms are commonly associated with rheumatoid arthritis?
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Who among RA patients is most likely to experience extraarticular manifestations?
Who among RA patients is most likely to experience extraarticular manifestations?
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Which joint is the most commonly affected in patients with RA?
Which joint is the most commonly affected in patients with RA?
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What may be the first symptom of cervical spine subluxation in RA patients?
What may be the first symptom of cervical spine subluxation in RA patients?
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Which of the following is a common misconception about RA's symptoms?
Which of the following is a common misconception about RA's symptoms?
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What is the aim of treatment in rheumatoid arthritis?
What is the aim of treatment in rheumatoid arthritis?
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What is important to consider when a patient presents extraarticular manifestations?
What is important to consider when a patient presents extraarticular manifestations?
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Which joint in the cervical spine is most commonly involved in RA?
Which joint in the cervical spine is most commonly involved in RA?
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Which of the following treatments can be used to provide symptomatic relief in RA?
Which of the following treatments can be used to provide symptomatic relief in RA?
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What is the initial dosage of methotrexate recommended for rheumatoid arthritis treatment?
What is the initial dosage of methotrexate recommended for rheumatoid arthritis treatment?
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Which type of DMARD is considered a first-line treatment for methotrexate non-responders?
Which type of DMARD is considered a first-line treatment for methotrexate non-responders?
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What common adverse effect is associated with methotrexate treatment?
What common adverse effect is associated with methotrexate treatment?
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Which of the following is a potential risk associated with TNF inhibitors?
Which of the following is a potential risk associated with TNF inhibitors?
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What is a characteristic of JAK inhibitors in rheumatoid arthritis treatment?
What is a characteristic of JAK inhibitors in rheumatoid arthritis treatment?
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What is a common comorbidity that increases mortality in rheumatoid arthritis patients?
What is a common comorbidity that increases mortality in rheumatoid arthritis patients?
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Which of the following non-pharmacologic treatments is recommended for rheumatoid arthritis?
Which of the following non-pharmacologic treatments is recommended for rheumatoid arthritis?
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What should be monitored due to the toxicity of conventional DMARDs?
What should be monitored due to the toxicity of conventional DMARDs?
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Study Notes
Rheumatoid Arthritis
- RA is a chronic inflammatory disorder of the joints, most common in women.
- Characterized by symmetrical inflammation affecting multiple joints.
- The synovium (lining of the joints) is the primary site of inflammation.
- Often associated with elevated serum levels of autoantibodies like rheumatoid factor (RF) and antibodies to citrullinated proteins (ACPA).
- Can cause joint destruction and deformity over time.
Epidemiology
- Native Americans have a higher prevalence.
- Females are affected 2-3 times more than males.
- Average age of onset in women is 40-60, slightly older in men.
- Affects approximately 1% of adults.
Pathophysiology/Etiology
- The exact cause is unknown, likely multifactorial.
- Genetic factors play a role, particularly variations in the HLA region.
- Environmental factors might include smoking, bacteria in mucosal sites, and viruses (Epstein-Barr virus and parvovirus B19).
- Hormonal factors: symptoms may improve during pregnancy.
- Autoantibodies (RF, ACPA) likely play a critical role
- ACPAs may target citrullinated proteins in the joint and deposit in synovial postcapillary venules, leading to inflammation.
Pathophysiology (Mechanism)
- The synovium becomes inflamed and proliferates, forming pannus.
- Pannus invades surrounding bone, cartilage, and ligaments.
- This leads to further damage and deformities.
- Genetic factors, bacterial or viral infections play a role.
- Immune system reaction causes joint damage
Clinical Features
- Hallmark is persistent symmetrical polyarthritis (synovitis).
- Affects hands and feet, although other joint lined by synovial membranes can be involved.
- Associated with fatigue, stiffness, weakness, flu-like symptoms, and muscle pain.
- Also common symptoms include loss of appetite and depression.
Which Joints are Affected?
- Primarily affects synovial joints.
- Affects peripheral joints, such as hands and feet, more commonly than axial joints.
- Can also affect the cervical spine (C1-C2).
Radiographic Features of RA
-
The mnemonic ABCDE'S helps to remember radiographic features:
- A - Alignment: Abnormal (may have bone erosion)
- B - Bones: Periarticular Osteoporosis.
- C - Cartilage: Uniform symmetric joint space loss
- D - Deformities: Swan neck, ulnar deviation, boutonnière
- E - Erosions: Marginal erosions
- S - Soft tissue: Swelling, nodules (often without calcification)
Extraarticular Manifestations
- These are non-joint manifestations (systemic) of RA. Examples include:
- General: Fever, Lymphadenopathy (swollen lymph nodes), weight loss
- Dermatologic: Palmar erythema, subcutaneous nodules
- Ocular: Episcleritis, Scleritis
- Pulmonary: Pleuritis, nodules
- Cardiac: Pericarditis, Myocarditis, Coronary vasculitis
- Neuromuscular: Entrapment neuropathy, peripheral neuropathy, mononeuritis multiplex
- Hematologic: Felty's syndrome
- Others: Sjögren's syndrome, amyloidosis and other issues
Which Patients with RA are Most Likely to Develop Extra-Articular Manifestations?
- Patients with RF and ACPA positivity
- HLA-DR4 positive.
- Males are more likely.
Pregnancy and RA
- Many patients experience remission of symptoms during pregnancy.
- Medications (e.g., methotrexate, leflunomide) should be discontinued for specific periods before conception to minimize potential fetal risks.
What Causes Increased Mortality?
- CVD (Cardiovascular Disease) is increased 1.5-2 fold
- Infections (e.g., pneumonia) is more frequent in RA patients
- Cancer (lymphomas, leukemias, lung cancer): increased 2-3 fold.
- Renal disease (from amyloidosis), gastrointestinal hemorrhage from NSAIDs can also result in increased mortality.
Treatment Goals
- Early treatment is crucial, ideally within 3-6 months of symptom onset.
- "Treat-to-target," aiming for low disease activity or remission.
Non-Pharmacologic Treatment
- Patient education
- Rest
- Exercise
- Heat and cold
- Splints
- Weight loss
Pharmacologic Treatment
- NSAIDs: for pain reduction
- Corticosteroids: symptomatic relief, but they don't stop disease progression
- DMARDs: Conventional DMARDs, Biologic DMARDs, Targeted Synthetic DMARDs:
- Reduce joint damage and preserve joint integrity
- Delayed onset of action
Investigations
- Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)
- Ultrasound or MRI.
- Rheumatoid factor (RF), anti-citrullinated antibodies (ACPAs).
- DAS28 score: evaluates disease activity
- X-rays: to monitor joint damage
- Functional assessments: evaluate physical function
- Urinalysis, Complete blood count, Chest X-ray, Urea and Creatinine, Liver function test: to monitor drug safety and general health
Surgery
- Synovectomy: removing the inflamed synovial membrane.
- Joint replacement.
- Excision of the metatarsal heads.
- Neurosurgery for atlantoaxial subluxation.
- Fusion of the wrist or ankle with joint damage.
Other Important Note
- The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis is used to diagnose and classify the disease.
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Description
Explore the key aspects of rheumatoid arthritis, including its symptoms, prevalence, and potential causes. This quiz covers important details about the disorder, focusing on its impact on different populations and the role of various factors in its development.
