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Four of the 7 criteria must be present, and at least 1 of
the first 4 must be present for at least 6 weeks.
• Morning stiffness in and around joints, lasting
>1 hour
• Arthritis of three or more joint areas involved
simultaneously
• Arthritis of at least one area in a wrist, metacarpophalangeal
(MCP), or proximal interphalangeal (PIP)
joint
• Symmetric arthritis involving the same joint areas
• Rheumatoid nodules
• Positive serum rheumatoid factor
• Erosions or periarticular osteopenia on PA hand and
wrist radiographs
i will pick D
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Hello Sami2004, I agree for four criteria but this patient already has four criteria
morning stiffness
symetric arthritis
hands involvement
positive antibody (Anti citrulin ab)
According to PR notes. Now, if you have antibody or xray changes you should start DMD
So, My guess is C.
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I would pick D...baseline radiological studies are required to evaluate disease progression and response.
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so now tell us right answer with explain ,if possible
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i will post answers tomorrow and more qs
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Ans. D ...from dr.red rheum lecture
The patient has the criteria for the diagnosis of Rheumatoid Arthritis. Once Rheumatoid arthritis is diagnosed, some baseline imaging study to evaluate the hands and the wrists must be performed. This will help to assess the severity of the disease at the time of initiation of therapy and also, for comparision with post treatment radiographs to evaluate response to the therapy . Plain radiographs of the hands and wrists are appropriate. Further managements depends upon the baseline severity of the disease at the time of diagnosis.
Mild RA : less than 6 inflamed joints, no extra-articular manifestations, no bony erosions or joint cartilage loss.
Moderate RA : Elevated ESR, Positive RA or positive Anti - CCP antibodies, radiographic changes such as osteopenia or small peripheral erosions and minimal joint space narrowing, no extra-articular disease.
Severe RA : imaging studies showing bony erosions and loss of cartilage, high titers of RF or Anti-CCP, presence of extra-articular manifestations, Anemia of chronic disease, Hypoalbuminemia.
Ans. A is incorrect. It is inappropriate to start therapy with out asessing baseline bone disease with an imaging study.
Ans. B is incorrect. It is inappropriate to start therapy with out asessing baseline bone disease with an imaging study. This option is appropriate if the patient is determined to have early, mild RA. Imaging must be performed to assess if this is mild or severe RA.
Ans. C is incorrect. It is inappropriate to start therapy with out asessing baseline bone disease with an imaging study. This option is correct if the patient is determined to have early, severe RA. Imaging must be performed to assess if this is mild or severe RA.
Ans. E is incorrect. The clinical criteria and positive anti-ccp suggest rheumatoid arthritis in this patient. There is no reason to obtain ANA.
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if the pt fits criteria for RA.. then isn't treatment next step in management
C
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hmmmm...i thought we start t first..thanks
