Alright, it's time for us to do a few quick review questions.
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.
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.
Stiffness greater than 30 minutes, you should always look for that
when you're thinking about an inflammatory rheumatologic disease.
Primarily affecting large joints, it does affect large joints but I wouldn't have used the word primarily.
And radiography reveals erosive changes, well that's definitely true.
So number three has got to be the right answer because it's not true.
More commonly we're talking about smaller joints like the PIPs, the MCPs, and certainly potentially the wrists.
Okay, next question. Rheumatoid nodules --
are painful to the touch, wrong. They're non-painful to the touch.
So that's definitely not correct. Rheumatoid nodules are most commonly found at the hips and shoulders, that's also false.
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.
Next stop, rheumatoid nodules can appear in visceral organs such as the lungs, well that's definitely true.
That would be the most common place to find a visceral rheumatoid nodule; would be in the periphery of the lungs.
And lastly, rheumatoid nodules are often premalignant lesions, and that's definitely false as well.
They're totally benign and you can reassure patients not to worry about them.
So our answer is clearly number three.
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.
Number two, anti-CCP is highly specific and highly sensitive for rheumatoid arthritis, and that's true, that's why we use that test.
The sensitivity is in the 80's but nonetheless I'd consider that to be highly sensitive.
Third, anemia is a rare finding, actually it's the most common hematologic finding in RA.
And lastly, ESR and CRP are typically low-normal, now that's not true either.
Especially if somebody's having acute synovitis with some inflammation and symptoms,
you expect their ESR and CRP to be modestly elevated.
So our answer is definitely number two.
And with that I think we're done talking about RA.