Rheumatoid Arthritis: Deformities, Diagnosis Criteria & Rehab MCQs

Rheumatoid Arthritis (RA)

Rheumatoid Arthritis is a chronic, systemic autoimmune disease characterized by symmetrical polyarthritis. It primarily targets the synovium (Synovitis), leading to cartilage and bone destruction.

1. Pathophysiology

• Target: Synovial membrane.
• Pannus: Thickened, inflamed synovium (granulation tissue) spreads over the articular cartilage, releasing enzymes that erode bone and cartilage ("Pannus destroys the joint").
• Pattern: Symmetrical, affecting small joints of hands/feet first (MCP, PIP). Spares the DIP joints.

2. Clinical Features & Deformities

• Morning Stiffness: Lasts > 1 hour (improves with activity).
• Hand Deformities:
  • Ulnar Deviation: At MCP joints (Z-deformity).
  • Swan Neck Deformity: PIP hyperextension + DIP flexion.
  • Boutonniere Deformity: PIP flexion + DIP extension.
• Extra-articular: Nodules, Vasculitis, Dry eyes (Sjogren's).

3. Diagnosis (ACR/EULAR Criteria)

Markers:
- Rheumatoid Factor (RF): Sensitive but not specific.
- Anti-CCP (ACPA): Highly Specific (>95%) for RA.
- X-ray: Peri-articular osteopenia, marginal erosions, symmetrical joint space narrowing.

4. Management

• DMARDs (Disease Modifying Anti-Rheumatic Drugs): Methotrexate (Gold standard), Sulfasalazine. Start early ("Window of Opportunity").
• Biologics: TNF-alpha inhibitors (e.g., Etanercept, Infliximab) for resistant cases.
• Surgery: Synovectomy, Arthroplasty (Joint replacement).

25 Practice MCQs

Q1. The hallmark pathology of Rheumatoid Arthritis is:

Answer: A). Inflamed synovium destroys the joint.

Q2. Which joints are typically SPARED in RA?

Answer: A). DIP involvement suggests OA or Psoriatic Arthritis.

Q3. Morning stiffness in RA typically lasts:

Answer: B). Improves with movement ("Gelling phenomenon").

Q4. The most specific antibody test for RA is:

Answer: A). Specificity > 95%.

Q5. Swan Neck Deformity consists of:

Answer: A). Often due to volar plate laxity or intrinsic tightness.

Q6. Boutonniere Deformity is caused by rupture of:

Answer: A). Lateral bands subluxate volarly, causing PIP flexion.

Q7. The first line DMARD of choice is:

Answer: A). Should be started as soon as diagnosis is made.

Q8. Felty's Syndrome triad includes:

Answer: A). A rare, severe complication.

Q9. Atlanto-axial subluxation in RA is dangerous because:

Answer: A). Transverse ligament destruction. Screen before surgery/intubation!

Q10. Caplan's Syndrome involves RA and:

Answer: A). Pulmonary manifestation.

Q11. Radiographic hallmark of RA is:

Answer: A). Bone is eaten away at the margins where synovium attaches.

Q12. Ulnar drift occurs at the:

Answer: A). "Z-deformity" (Radial deviation of wrist, Ulnar deviation of fingers).

Q13. Baker's Cyst in RA is caused by:

Answer: A). High pressure synovitis.

Q14. Sjogren's Syndrome secondary to RA involves:

Answer: A). Autoimmune attack on exocrine glands.

Q15. Rheumatoid nodules are typically found on:

Answer: A). Pressure points.

Q16. Arthroplasty (Replacement) in RA is done to:

Answer: A). Does not stop the systemic disease.

Q17. Is RA symmetrical?

Answer: A). Key distinguishing feature.

Q18. "Piano Key" sign at the wrist indicates:

Answer: A). Caput Ulnae syndrome.

Q19. Which gender is more affected?

Answer: A). Common in middle-aged women.

Q20. Trigger finger in RA is often due to:

Answer: A). Pulley release alone can be dangerous (bowstringing).

Q21. Juvenile Idiopathic Arthritis (JIA) differs from RA by:

Answer: A). Has several subtypes (Oligo, Poly, Systemic).

Q22. Synovectomy prevents joint destruction by:

Answer: A). Preventive surgery.

Q23. Rupture of the Extensor Pollicis Longus (EPL) occurs at:

Answer: A). Due to attrition on rough bone (Vaughan-Jackson lesion).

Q24. Does cold weather cause RA?

Answer: B). Myth vs reality.

Q25. Biologics (TNF Inhibitors) increase the risk of:

Answer: A). Mandatory TB screening before starting.