Question 1

Which are symptoms of rheumatoid arthritis (RA) that distinguish it from osteoarthritis (OA)? (Select all that apply.)&#10;A) Extra-articular inflammatory signs&#10;B) History of injury to affected joints&#10;C) Morning stiffness of at least 1 hour&#10;D) Symmetric tender, swollen joints&#10;E) Unilateral joint involvement

Accepted Answer

Extra-articular inflammatory signs such as fever, fatigue, and other systemic symptoms are more common in RA than OA. Morning stiffness lasting at least 1 hour is also a hallmark of RA. Additionally, RA tends to cause symmetric joint involvement, meaning the same joints on both sides of the body are affected, while OA is more commonly unilateral or affects joints on one side of the body.

Question 2

A patient is diagnosed with rheumatoid arthritis (RA) after a review of systems, confirmatory lab tests, and synovial fluid analysis. What will the provider order initially to treat this patient?&#10;A) Disease-modifying anti- rheumatic (DMARDs) drugs&#10;B) Long-term glucocorticoid therapy&#10;C) Non-pharmacological treatments&#10;D) Nonsteroidal anti-inflammatory drugs (NSAIDs)

Accepted Answer

Disease-modifying anti-rheumatic drugs (DMARDs) are the mainstay of treatment for rheumatoid arthritis. They help slow or stop the progression of the disease by suppressing the immune system's attack on joints. Long-term glucocorticoid therapy may be used in combination with DMARDs, but it is not the initial treatment. Non-pharmacological treatments (such as physical therapy and assistive devices) may be used in conjunction with drug therapy, but they are not a primary treatment option. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for pain relief, but they do not modify the disease or prevent joint damage.

Question 3

A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A rheumatoid factor (RF) test is negative. What will the primary care provider do next?

A) Begin treatment with a biologic disease-modifying anti-rheumatic (DMARD) drug
B) Order radiographic tests, a CBC, and acute-phase reactant levels
C) Reassure the patient that the likelihood of rheumatoid arthritis is low
D) Refer the patient to an orthopedic specialist for evaluation and treatment

B

Accepted Answer

The negative RF test does not rule out rheumatoid arthritis (RA), as some patients may have seronegative RA. Therefore, further evaluation is necessary. Ordering radiographic tests, a complete blood count (CBC), and acute-phase reactant levels can help the primary care provider assess for joint damage, inflammation, and systemic involvement. Based on the results, the primary care provider may refer the patient to a rheumatologist for further management or continue monitoring the patient's symptoms. Beginning treatment with a biologic DMARD is premature without a definitive diagnosis. Reassuring the patient without further diagnostic evaluation may be inappropriate and delay appropriate treatment. Referring the patient to an orthopedic specialist may address joint damage but does not evaluate for underlying systemic disease.

Deck 197: Rheumatoid Arthritis