Quick Review: Rheumatoid Arthritis

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.

02:22 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.

02:42 So our answer is definitely number two.

02:46 And with that I think we're done talking about RA.