Rheumatoid Arthritis Quiz

See Presentation. Option D is correct. Rheumatoid arthritis is an inflammatory arthritis: the lining of the joints (the synovium) is inflamed, so the joints are swollen, warm and stiff, and typically both sides are affected (symmetrical), especially the small joints of the hands and feet. The classic presentation is recalled as the 3 S's: Stiffness, Swelling and Squeezing. The stiffness is worse in the morning and lasts more than 30 minutes, often an hour or more, because inflammation builds up during rest. The swelling is persistent and boggy. The squeeze test is positive when squeezing across the knuckles (the metacarpophalangeal joints) hurts, which is a sign of active synovitis. Osteoarthritis is a degenerative (wear and tear) arthritis with a different pattern: pain is mechanical, worse with activity and better with rest, stiffness lasts less than about 30 minutes, and the joints are usually bony rather than boggy, with Heberden nodes at the distal interphalangeal joints and no marked inflammation. Rheumatoid arthritis typically spares the distal interphalangeal joints.

• Pattern: rheumatoid arthritis is inflammatory and symmetrical, mainly affecting the small joints of the hands and feet
• Stiffness: worse in the morning and lasting more than 30 minutes, often an hour or more
• Squeeze test: pain on squeezing across the knuckles shows active synovitis