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Medicine

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Rheumatology

Question
4 out of 30
 

Which of the following joint is least likely involved inRA? (AI 02)



A PIP
B Wrist

C DIP
D Elbow

Ans. C DIP (Ref: H-2086) DIP involvement is not a feature. (FAQ)

Diagnostic criteria(As given in 17thEdt of Harrison, Pg 2089) –Four of seven criteria are required Q

1. Morning stiffness – lasting 1 hour before maximal improvement

2. Arthritis of 3 or more joint areas – 14 possible joint areas are right or left PIP MCP, wrist, elbow, knee, ankle and MTP joints

3. Arthritis of hand joints.

4. Symmetrical arthritis.

5. Rheumatoid nodules. Q

6. Positive Serum rheumatoid factor Q

7. Radiographic changes – including erosions or unequivocal bong decalcification localized in or most marked adjacent to the involved joint.

Note: There is change in diagnostic criteria of RA in 18th Edition of Harrison

Table 321-1 Classification Criteria for Rheumatoid Arthritis (Ref: H-18th edition, Pg-2745, table 321.1)

Score

Joint involvement 1 large joint (shoulder, elbow, hip, knee, ankle) 0

2–10 large joints 1

1–3 small joints (MCP, PIP, Thumb IP, MTP, wrists) 2

4–10 small joints 3

>10 joints (at least 1 small joint) 5

Serology Negative RF and negative ACPA 0

Low-positive RF or low-positive anti-CCP

antibodies (3 times ULN) 2

High-positive RF or high-positive anti-CCP

antibodies (>3 times ULN) 3

Acute-phase reactantsNormal CRP and normal ESR 0

Abnormal CRP or abnormal ESR 1

Duration of symptoms <6 weeks 0

6 weeks 1

Note: application of the newly revised criteria yields a score of 0-10, with a score of ≥ 6 fulfilling the requirements for definite RA. (Harrison 18th, page 2745)

Extra Edge: DIP involvement occurs in OA & Psoriasis

Rheumatology Flashcard List

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