Rheumatoid Arthritis: Diagnosis, Radiographic Findings, and Juvenile Idiopathic Arthritis, Exams of Rheumatology

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Wk- Rheumatoid Arthritis

RA is: a. seronegative b. seropositive - ANS B To be diagnosed with RA a patient must be positive for one or both of which two antibodies: - ANS Rheumatoid Factor (RF) and/or ACPA (anticitrullinated peptide antibody) Which of the following is a diagnostic criterion for RA? a. Elevated blood pressure b. Positive rheumatoid factor (RF) c. Low hemoglobin levels d. Increased cholesterol levels - ANS B The target tissue in rheumatoid arthritis is the: - ANS synovium T/F RA primarily targets the synovial tissue in peripheral joints, excluding the hands and feet. - ANS False Which antibodies are associated with RA? a. ANA (Antinuclear Antibody) b. RF (Rheumatoid Factor) and/or ACPA (Anti-Citrullinated Peptide Antibody) c. Anti-dsDNA (Anti-Double-Stranded DNA) d. Anti-CCP (Anti-Cyclic Citrullinated Peptide) - ANS B

T/F Rheumatoid Arthritis (RA) is characterized by targeting primarily the bones rather than the synovium. - ANS False Rheumatoid synovitis is the result of a ______ immune response to an antigen present in the synovial membrane. - ANS cellular Which is not a common site of RA: a. wrist, knee, elbow b. cervical spine c. lumbar spine d. GH and AC joints - ANS C RA is most commonly seen in: - ANS 20-60 yrs -female 3:1 before age 40 -1:1 female/male after 40 Juvinille RA is characterized by onset before age: a. 10 b. 12 c. 14 d. 16 - ANS D T/F - the morning stiffness associated with RA typically dissipates within 1 hour - ANS False- lasts more than 2 hours T/F Juvenile RA typically has an abrupt onset. - ANS False- it has an insidious onset

Haygarth's nodes of the DIPs are called: a. heberden's nodes b. Bouchard's nodes c. Ranvier's nodes - ANS A Haygarth's nodes of the PIPs are called: a. heberden's nodes b. Bouchard's nodes c. Ranvier's nodes - ANS B Match the clinical feature witht he correct condition: a. Xeroderma 1. Drymouth b. Xeropthalmia 2. Soft tissue swelling c. Xerostomia 3. dry eyes d. Haygarth's nodes 4. dry skin e. Rheumatoid nodules 5. subcutaneous lumps - ANS A. 4 B. 3 C. 1 D. 2 E. 5 The 3 main finger deformities associated with RA are: - ANS -Mallet Finger -Boutonnier deformity -Swan-neck deformity

Flexion of PIP and hyperextension of DIP: a. Mallet finger b. Boutonniere deformity c. swan-neck deformity - ANS B Flexion of the DIP: a. Mallet finger b. Boutonniere deformity c. swan-neck deformity - ANS A Hyperextension of PIP and flexion of DIP: a. Mallet finger b. Boutonniere deformity c. swan-neck deformity - ANS C One of the first radiographic signs of RA: - ANS periarticular soft tissue swelling (particularly of MCP's and wrist) Marginal erosions are AKA: - ANS Rat Bites marginal erosions occur at what aspect of the joint: - ANS the bare area (where there is no cartilage, only synovial membrane) juxta-articular osteoporosis - ANS loss of bone density near the joint What is a characteristic feature of Rheumatoid Arthritis (RA) compared to Osteoarthritis (OA) regarding joint space loss?

a. Non-uniform loss of joint space b. Uniform loss of joint space c. No loss of joint space d. Fluctuating loss of joint space - ANS B T/F Juxta-articular periostitis is a common feature of RA radiography. - ANS True In the wrist, what is often the first site of erosion in RA - ANS the ulnar styloid process T/F widening of the Atlanto-dental interval is a sign of instability and you should NOT obtain a flexion view - ANS True The referral for a widened ADI: - ANS Neurosurgeon Subaxial subluxations can be diagnosed in RA patients with translation greater than ______ mm while in non-arthritic patients, the translation would need to be greater than _________mm - ANS 3mm, 3.5mm In RA of the cervical spine, you will have osteophytes and sclerosis similar to DJD - ANS False- no osteophytes or sclerosis T/F X-ray exam of RA patients must include the standard series with the addition of a flexion view - ANS True Erosion of the dens in RA gives what appearance: - ANS a "whittled" appearance what are the 3 common radiographic findings of RA in the cervical spine - ANS -erosion of dens (pannus formation)

-endplate erosions -fusion T/F Atlantoaxial subluxation is more commonly associated with posterior translation than anterior in Rheumatoid Arthritis (RA). - ANS False- mostly anterior translation Vertical subluxation of the cervical spine refers to what: - ANS basilar impression Subaxial subluxation of the cervical spine is given what description: - ANS stepladder appearance subluxation of the cervical spine is always described as the segment _______________ in relation to the segment ____________ - ANS above, below Generalized osteopenia of the cervical spine in RA patients occurs as a result of: - ANS extended corticosteriod usage In the hand, there is a minimum of _____ to _______ months from onset until radiographic manifestation: a. 1-3 months b. 3-6 months c. 6-9 months d. 8-10 months - ANS B The MC location for earliest articular changes in the hand will occur at: - ANS radial aspect of the 2nd and 3rd metacarpal heads, and radial margins of distal and proximal ends of proximal phalanges The earliest changes in the hand due to RA are:

The earlier articular changes in the hand are: - ANS soft tissue swelling marginal erosions T/F Ulnar styloid process is an uncommon site of erosion in Rheumatoid Arthritis - ANS False- it's often the first site of erosion In the hand, Rheumatoid Arthritis (RA) typically involves MCP and PIP joints, with the ______ being often spared until late in the disease. - ANS DIP What is the recommended addition to a standard X-ray series for Rheumatoid Arthritis (RA) patients with cervical spine involvement? a. Flexion view b. Lateral view c. Oblique view d. AP (Anteroposterior) view - ANS A RA in the hip is associated with __________ migration: a. superior b. axial c. medial - ANS B Protrusio acetabuli occurs in what percent of RA patients: - ANS 15% How is SI joint RA different: - ANS It's typically erosions that can be unilateral or bilateral and asymmetrical T/F SI joint involvement in RA is usually mild - ANS True

RA of the GH joint is characterized by: - ANS superior migration of humeral head and narrowed acromiohumeral interval Visualization of what feature at the elbow in the absense of trauma should lead you to suspect RA (or infection) - ANS posterior fat pad displacement of the anterior fat pad (sail sign) is indicative of what? - ANS radial head fracture Loss of joint space, instability, possible bony ankylosis: a. SI joint b. cervical spine c. hand d. shoulder - ANS B Unilateral or bilateral asymmetric erosions: a. SI joint b. cervical spine c. hand d. shoulder - ANS A RA + pneumoconiosis a. Felty's syndrome b. Jung's syndrome c. Caplan's syndrome d. Nelson's syndrome - ANS C

RA+ leukopenia & splenomegaly: a. Felty's syndrome b. Jung's syndrome c. Caplan's syndrome d. Nelson's syndrome - ANS A In cases of disease lasting more than 14 years, what is a possible systemic finding: - ANS Superior rib erosions What are the most common ribs involved: - ANS 3- T/F Cardiomegaly is a common systemic finding in Rheumatoid Arthritis - ANS True T/F No single laboratory test, histologic finding, or radiographic feature confirms a diagnosis of RA - ANS true What is the most common disease-modifying anti-rheumatic drug (DMARD) used in the treatment of Rheumatoid Arthritis? a. Prednisone b. Ibuprofen c. Methotrexate d. Aspirin - ANS C T/F Periostitis is more common in JIA than in adult RA - ANS True Is there a contraindication to adjustment with JIA - ANS Yes- in the involved joints

What is the most common form of Juvenile Idiopathic Arthritis (JIA)? a. Juvenile onset, adult-type rheumatoid arthritis b. Juvenile psoriatic arthritis c. Seronegative chronic arthritis (Still disease) d. Juvenile onset, adult-type ankylosing spondylitis - ANS C JIA peaks at _______ and _________ years of age - ANS 2-5 and 9- What is a characteristic radiographic feature of Juvenile Idiopathic Arthritis (JIA)? a. Asymmetrical joint space narrowing b. Pannus formation c. Ballooned epiphyses d. Juxta-articular sclerosis - ANS C T/F JIA peaks at two distinct age ranges: 2-5 years and 9-12 years. - ANS True Articular erosions are (more or less) common compared to adult RA - ANS less Which is not a clinical feature of JIA a. cardiomegaly b. fever/rash c. iridocyclitis d. receded, hypoplastic mandible - ANS A

T/F JIA typically does not affect growth - ANS False- it causes growth disturbances by ballooned epiphyses and early closure of growth plates What are the 3 major things to look for in JIA: - ANS -periostitis -erosions -juxta-articular osteoporosis The stepladder appearance that can be seen with rheumatoid arthritis is most common at what levels? C1-C C4-C C6-C C2-C4 - ANS D During the pathophysiology of rheumatoid arthritis, what happens to the synovial tissue? a. None of the above b. Necrosis c. Hyperplasia d. Hypoplasia - ANS C Which of the following is NOT a clinical feauture of rheumatoid arthritis? a. Anuerysms b. Nodules c. Sjogren's syndrome d. Carpal tunnel syndrome - ANS A What percentage of patients with Rhuematoid arthritis are ACPA positive?

a. 50 b. 70 c. 40 d. 80 - ANS B Still's disease is also known as which of the following? a. Classic systemic form b. seronegative chronic arthritis c. Polyarticular form d. Pauciarticular or monoarticular form - ANS B T/F Uniform loss of joint space is typically seen early on in juvenile idiopathic arthritis? - ANS False- only late