00:00
Alright, it's time for us to do a few quick review questions.
00:03
Remember I'm gonna ask a question, feel free to pause this screen
and come up with your own answer and then we'll review the answer.
00:10
Which of the following is not a classic feature of rheumatoid arthritis?
Alright, well one of the classic features of RA is symmetric joint involvement, so that's gonna stay there.
00:23
Stiffness greater than 30 minutes, you should always look for that
when you're thinking about an inflammatory rheumatologic disease.
00:29
Primarily affecting large joints, it does affect large joints but I wouldn't have used the word primarily.
00:36
And radiography reveals erosive changes, well that's definitely true.
00:40
So number three has got to be the right answer because it's not true.
00:45
More commonly we're talking about smaller joints like the PIPs, the MCPs, and certainly potentially the wrists.
00:53
Okay, next question. Rheumatoid nodules --
are painful to the touch, wrong. They're non-painful to the touch.
01:04
So that's definitely not correct. Rheumatoid nodules are most commonly found at the hips and shoulders, that's also false.
01:11
We know that rheumatoid nodules are much more commonly found at the olecranon,
at the Achilles tendon, maybe in the forearm, but not the hips and shoulders.
01:19
Next stop, rheumatoid nodules can appear in visceral organs such as the lungs, well that's definitely true.
01:26
That would be the most common place to find a visceral rheumatoid nodule; would be in the periphery of the lungs.
01:31
And lastly, rheumatoid nodules are often premalignant lesions, and that's definitely false as well.
01:38
They're totally benign and you can reassure patients not to worry about them.
01:41
So our answer is clearly number three.
01:44
Okay, one last question. Which of the following is true of rheumatoid arthritis?
Okay, anti-double-stranded DNA antibodies are highly specific for rheumatoid arthritis,
now I'm hoping that you're thinking anti-DS DNA antibodies
are associated with lupus not rheumatoid arthritis, so that's one off the list.
02:09
Number two, anti-CCP is highly specific and highly sensitive for rheumatoid arthritis, and that's true, that's why we use that test.
02:18
The sensitivity is in the 80's but nonetheless I'd consider that to be highly sensitive.
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Third, anemia is a rare finding, actually it's the most common hematologic finding in RA.
02:28
And lastly, ESR and CRP are typically low-normal, now that's not true either.
02:34
Especially if somebody's having acute synovitis with some inflammation and symptoms,
you expect their ESR and CRP to be modestly elevated.
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So our answer is definitely number two.
02:46
And with that I think we're done talking about RA.