A 39-year-old woman with a history of rheumatoid arthritis presents with a two day history of a red right eye. There is no itch or pain. Pupils are 3mm, equal and reactive to light. Visual acuity is 6/5 in both eyes.
What is the most likely diagnosis?
Correct Answer D: Scleritis is painful, episcleritis is not painful.
Rheumatoid arthritis: ocular manifestations: Ocular manifestations of rheumatoid arthritis are common, with 25% of patients having eye problems.
Ocular manifestations:
Iatrogenic:
Which one of the following is most useful in the management of Familial Mediterranean Fever?
Correct Answer D:
Familial Mediterranean Fever:
Familial Mediterranean Fever (FMF, also known as recurrent polyserositis) is an autosomal recessive disorder which typically presents by the second decade. It is more common in people of Turkish, Armenian and Arabic descent.
Features - attacks typically last 1-3 days:
Management:
A 64-year-old female is referred to rheumatology out-patients by her GP with a history of arthritis in both hands. Which one of the following x-ray findings would most favour a diagnosis of rheumatoid arthritis over other possible causes?
Correct Answer B: Periarticular osteopenia and osteoporosis would point towards a diagnosis of rheumatoid arthritis (RA). Loss of joint space is common in both RA and osteoarthritis.
Rheumatoid arthritis: x-ray changes:
Early x-ray findings:
Late x-ray findings:
A 33-year-old man who is suspected of having ankylosing spondylitis has a lumbar spine x-ray.
Which one of the following features is most likely to be present?
Correct Answer B: Ankylosing spondylitis - x-ray findings: subchondral erosions, sclerosis and squaring of lumbar vertebrae.
Ankylosing spondylitis: features:
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 5:1) aged 20-30 years old.
Features:
Clinical examination:
Other features - the 'A's:
A 40-year-old woman complains of a permanent 'funny-bone' sensation in her right elbow. This is accompanied by tingling in the little and ring finger. Her symptoms are worse when the elbow is bent for prolonged periods.
Correct Answer A:
Elbow pain:
The table below details some of the characteristic features of conditions causing elbow pain:
Click to expand