Rheumatoid Arthritis: The Daily PANCE Blueprint
A 42-year-old patient presents with morning stiffness in her hands and wrists for the past few months. She also has been more fatigued. Physical exam is remarkable for ulnar deviation of the hand with swelling around the MCP and PIP joints. Which of the following is most likely to be positive in this patient?
A. anti-citrullinated protein antibody
B. anti-smith antibodies
C. anti-GBM antibodies
D. anti-centromere antibodies
E. antineutrophil cytoplasmic antibody
Answer and topic summary
The answer is A. anti-citrullinated protein antibody
Rheumatoid arthritis is an autoimmune polyarthritis with no known cause. Symptoms include morning stiffness, swelling of joints, depression, fatigue. The main signs of early RA include symmetric effusions and swelling around MCP and PIP joints. About 80% of patients with RA will test positive for rheumatoid factor, anti-citrullinated protein antibody, or body. Often patients will have elevations of ESR and CRP too (this is nonspecific). Other laboratory findings you may see include leukocytosis, anemia, and thrombocytosis. Plain radiographs of joints may be NORMAL early in the disease. Treatment includes disease-modifying antirheumatic drug (DMARD) therapy (e.g., methotrexate) and the use of anti-inflammatory therapies (NSAIDs, steroids) to help control symptoms
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ ⇒
Also covered in the Internal Medicine and Family Medicine PAEA EOR topic lists
