Rheumatoid Arthritis

Chapter 49 Rheumatoid Arthritis




Clinical Case Problem 1 A 35-Year-Old Woman with Malaise and Vague Periarticular Pain and Stiffness


A 35-year-old woman comes to your office with a 6-month history of malaise, paresthesia in both hands, and vague pain in both hands and wrists. She also has felt extremely fatigued. She tells you that the pains in her joints are much worse in the morning. She is also beginning to notice pain and swelling in both knees. The patient has a normal family history, with no significant diseases noted. She is taking no drugs and has no allergies. On examination, vital signs are normal. There is a sensation of bogginess and slight swelling in both wrists and multiple metacarpophalangeal joints. Both knees also feel somewhat swollen and boggy. There are no other joint abnormalities, and the rest of the physical examination is normal.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. nonarticular rheumatism

b. synovitis

c. gonococcal arthritis

d. rheumatoid arthritis

e. systemic lupus erythematosus

2. What is the most characteristic symptom of this disease?


a. early morning joint stiffness

b. progressive joint pain

c. predilection for the small joints

d. joint swelling

e. rash

3. What is the most characteristic sign of this disease?


a. joint swelling

b. bilateral (symmetric) joint involvement

c. erythema surrounding the affected joints

d. joint bogginess

e. involvement of the glenohumeral joint in all cases

4. On what is the pathophysiologic process of this disease based?


a. bone destruction

b. bone spur formation

c. bone sclerosis

d. symmetric joint involvement

e. synovial inflammation

5. In the course of this disease, which of the following pathophysiologic changes is most characteristic?


a. synovial proliferation with cartilage erosion stimulated by cytokines

b. cartilage destruction stimulated by the proliferation of proteoglycans

c. cartilage destruction stimulated by the enzymatic action of proteoglycans

d. loss of the synovial membrane

e. none of the above (the pathophysiologic mechanism of the disease is not known with any certainty)

6. The disease described tends to affect which particular part of the spine?


a. C1-2

b. C6-7

c. T7-8

d. L1-2

e. L4-5

7. Which anemia usually accompanies this disease process?


a. microcytic, hypochromic

b. microcytic, normochromic

c. normocytic, normochromic

d. macrocytic, hyperchromic

e. normocytic, hypochromic

8. Which of the following is (are) a systemic complication(s) of the disease process?


a. vasculitis

b. pericarditis

c. pleural effusion

d. diffuse interstitial fibrosis of the lung

e. all of the above

9. Felty syndrome is a complication of the described disorder. Which of the following is part of this syndrome?


a. hepatomegaly

b. hyperkalemia

c. proteinuria

d. splenomegaly

e. thrombocytopenia

10. For the described disorder, which of the following is (are) a proven disease-modifying agent(s)?


a. auranofin

b. adalimumab

c. hydroxychloroquine

d. methotrexate

e. all of the above

11. The patient develops a local flare-up in her right knee. Her left knee is affected to a small degree but not nearly as severely as the right knee. Up until this time, remission had been maintained, and she was taking oral antiinflammatory agents for suppression of inflammation. What is the treatment of choice for this local flare-up?


a. methotrexate

b. hydroxychloroquine

c. intraarticular corticosteroid injection

d. oral prednisone

e. auranofin

12. What is the drug of choice for the suppression of inflammation in a patient with this disease?


a. auranofin

b. methotrexate

c. oral prednisone

d. naproxen

e. D-penicillamine

13. Which of the following is not a classic radiologic feature of rheumatoid arthritis?


a. loss of periarticular bone mass

b. narrowing of the joint space

c. bone erosions

d. subarticular sclerosis

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Rheumatoid Arthritis

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