Rheumatoid arthritis
Types of deformities in rheumatoid arthritis?
Ulnar deviation, “Swan-neck” deformity, Boutonnière” or “buttonhole” deformity
Which drugs are used as basic therapy in ankylosing spondylitis, and what is their goal?
➤ NSAIDs to reduce pain and inflammation; biologics (TNF-α or IL-17 inhibitors) to control disease activity.
Explain why gout commonly affects peripheral joints rather than central joints
Lower temperature in peripheral joints promotes urate crystal precipitation
A patient with reactive arthritis doesn’t respond to NSAIDs. What should be the next step in treatment?
Intra-articular or systemic glucocorticoids; consider DMARDs (sulfasalazine, methotrexate).
How can osteoarthritis of the knee be differentiated from rheumatoid arthritis by morning stiffness?
In OA, stiffness less than 30 minutes; in RA, more than one hour.
Why is “bridge therapy” used when starting methotrexate?
To control inflammation and pain until the DMARD takes effect.
Какие рентгенологические изменения наблюдаются в крестцово-подвздошных суставах при болезни Бехтерева?
Сакроилеит — склероз, эрозии и сужение суставной щели, возможно прогрессирующее до анкилоза.
Which is the gold standart dianostic method in gout?
Identification of monosodium urate (MSU) crystals in synovial fluid or tophus aspirate under polarized light microscopy.
Appearance: Needle-shaped crystals
A 28-year-old man develops pain and swelling in the right knee 2 weeks after a urethritis episode. What test will help confirm the diagnosis of reactive arthritis?
Answer: PCR or ELISA for Chlamydia trachomatis
A patient with osteoporosis complains of back pain and loss of height. What should you suspect?
➡️ Vertebral compression fractures.
The levels of disease activity in RA
DAS28 Score Disease Activity
> 5.1High disease activity
3.2 – 5.1Moderate disease activity
2.6 – 3.2Low disease activity
< 2.6Remission
A young man with chronic back pain does not respond well to NSAIDs. What is the next recommended therapy according to current guidelines?
➤ Initiate biological treatment with TNF-α or IL-17 inhibitors.
How would you manage a patient with frequent gout attacks and hyperuricemia between attacks?
Start urate-lowering therapy (allopurinol or febuxostat), monitor serum uric acid, maintain lifestyle modifications.
A patient with reactive arthritis still has inflammation 6 months after onset. What should be done?
Evaluate for chronic spondyloarthritis; initiate DMARD therapy (sulfasalazine or methotrexate).
A 68-year-old patient complains of knee pain that worsens with walking and morning stiffness lasting less than 30 minutes. Which diagnostic method is most informative to confirm osteoarthritis?
X-ray of the joints in two projections.
A patient with RA wants to become pregnant. How would you manage her medications?
Stop teratogenic drugs (methotrexate, leflunomide), consider pregnancy-safe DMARDs (hydroxychloroquine, sulfasalazine), plan therapy with rheumatologist and obstetrician.
What is BASDAI ?
Bath Ankylosing Spondylitis Disease Activity Index. 0 – 2 Inactive or minimal activity
2 – < 4 Moderate disease activitySome symptoms present;
≥ 4 – < 6 High disease activity
≥ 6 – 10Very high disease activity
A patient with acute gout attack has severe renal impairment. Which drug should you avoid?
NSAIDs (may worsen kidney function).
A patient presents with painful urination, red eyes, and swollen ankle joints. Which syndrome is this, and what is the triggering infection?
Reiter’s syndrome; often triggered by Chlamydia trachomatis.
A 65-year-old woman has a T-score of –2.6.
How should this result be interpreted?
➡️ This indicates osteoporosis (T-score ≤ –2.5). Treatment is required
Question: A patient with RA and early erosions on X-ray continues to have active inflammation despite methotrexate. What is the next step in therapy?
Consider adding a biologic drug or combination DMARD therapy.
A patient with ankylosing spondylitis develops eye pain and redness. What complication should you suspect, and what referral is needed?
➤ Anterior uveitis — refer to an ophthalmologist.
A 50 year old man presents with his first gout attack. His serum uric acid is elevated. Should long-term urate -lowering therapy be started immediately after the acute attack?
No. Urate- lowering therapy should not be started during an acute attack because fluctuations in uric acid levels can worsen inflammation.
What joint pattern (distribution) is most typical for reactive arthritis?
Asymmetric oligoarthritis of lower limbs (knees, ankles).
A 70-year-old woman taking bisphosphonates complains of stomach pain and difficulty swallowing.
What could be the cause and how can it be prevented?
Improper intake of bisphosphonates — they should be taken with water on an empty stomach while standing, and the patient must not lie down for 30–60 minutes.