Indian Journal of Rheumatology 2007 September

PG Forum
Volume 2, Number 3; p. 122

Rheumatology quiz
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V Arya1, V Dhir2
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 03/17/2023

1. Uveitis associated with pauciarticular-onset JIA is char- 6. Treatment with infliximab was found to be
acterized by the following, except: (a) Effective for giant cell arteritis but not for polymyal-
(a) ANA positivity gia rheumatica
(b) Anterior uveitis (b) Effective for polymyalgia rheumatica but not for
(c) Preponderance in girls giant cell arteritis
(d) Rarity of visual loss (c) Effective for both
2. The revised criteria of the International Society of (d) Ineffective for both
Thrombosis and Hemostasis for the diagnosis of anti- 7. All are true for bisphosphonate-related osteonecrosis of
phospholipid syndrome (2006) have fixed the cut-off the jaw, except
value for anticardiolipin antibodies (aCL) at (a) Not reported so far with risedronate
(a) 20 GPL/MPL units (b) Self-limiting
(b) 30 GPL/MPL units (c) More common with zoledronic acid and
(c) 40 GPL/MPL units pamidronate
(d) 50 GPL/MPL units (d) Surgical debridement should be avoided
3. The factor most strongly predictive of osteoporotic ver- 8. All of the following are true for Felty’s syndrome, except
tebral fractures is (a) Leucopenia is because of lymphopenia
(a) Short stature (b) 95% of patients are HLA DR4 positive
(b) A past history of vertebral fractures (c) There is an increased risk of non-Hodgkin’s
(c) Early menopause lymphoma
(d) Obesity (d) Chronic non-healing ulcers are a major complication
4. The Beighton scoring system for joint hypermobility 9. In a lupus patient who has delivered one child with
includes all the following passive manoeuvres, except complete heart block, the chances of recurrence in a
(a) Apposition of the thumb to the flexor aspect of the subsequent pregnancy are approximately
forearm (a) 5%
(b) Hyperextension of the elbow (b) 15%
(c) Passive dorsiflexion of the 4th metacarpophalangeal (c) 50%
joint (d) 75%
(d) Hyperextension of the knee 10. Which of the following drugs can be safely administered
5. Mixed connective tissue disease usually spares to a patient with liver dysfunction
(a) Gastrointestinal tract (a) Cyclosporine
(b) Lungs (b) Colchicine
(c) Kidneys (c) Azathioprine
(d) Skin (d) Mycophenolate mofetil
For answers refer to page 130

1
Department of Medicine, JIPMER, Pondicherry, 2Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow, India.
Correspondence: Dr. V Arya, email: linuxphoenix@gmail.com
130 Indian Journal of Rheumatology 2007 September; Vol. 2, No. 3
2007; 34: 616; original paper on page 696]. Even die-hard
anti-GC groups are coming around and accepting that GC
may really not be that bad if used with DMARDs. In the
same context EULAR 2007 presentation by Kleinman’s
group [CADERA study: ‘Steroids Are DMARDS: MTX Plus
Prednisolone Provides Durable Benefit in RA’; Choy EH,
Smith CM, Chau L, et al. “A window of opportunity” in
early rheumatoid arthritis: sustained effects of step-down
prednisolone on joint damage. Presented at: EULAR 2007
Meeting; June 13, 2007; Barcelona, Spain. Abstract OP0006]
further strengthens the same concept. Highly recommended
reading. Interestingly, GC use in RA reduced lymphoma
risk [EULAR 2007 Barcelona, Abstract OP0047]! While on
GC use, how interesting; while in RA GC is increasingly
being accepted, it is just the opposite in SLE. RheumaPandit
would say ‘use GCs sparingly in SLE, and only in life-
threatening situations’. It should not be used as a ‘back-
ground’ treatment, should be tapered off as rapidly as possible
once the acute emergency is over. Of course you would
remember the earlier quoted paper by Appenzeller S et al.
in this issue [Hippocampal atrophy in systemic lupus ery-
thematosus. Ann Rheum Dis 2006; 65: 1585–1589]. Now
read it with expert comments [Nature Clin Pra Rheumatol
2007; 3: 124], yet another reason not to use long-term
background GC without any definite indication.
RheumaPandit has repeatedly emphasised the impor-
tant role of statins in systemic autoimmune inflammatory
diseases. Another recent paper reconfirms the same [J
Rheumatol 2007; 34: 964]. Adding to the fact that stroke
specialists urge more attention to hyperlipidaemia [Stroke
2007; 38: 281]; most patients with systemic autoimmune
inflammatory diseases have dyslipidaemia. Rheumatologists
must be proactive in preventing premature atherosclerosis.
However, RheumaPandit has been worried about proinflam-
matory HDL problem. There is no easy way to estimate it in
routine clinical practice. Therefore, despite the fact that it is
bad for blood vessels and improves only with high-dose
statins [J Rheumatol First Release June 1 2007], how does
one apply this knowledge in routine practice?
RheumaPandit came across a lovely paper on HCQ
reducing cancer risk in SLE [Ann Rheum Dis 2007; 66;
ANSWERS TO THE RHEUMATOLOGY QUIZ
(page 122)
1d*, 2c, 3b, 4c**, 5c, 6d***, 7b†, 8a††, 9b, 10d
* †
Visual loss is a common and serious complication.
**
5th metacarpal joint.
815]. How nice! Another reason why every patient with
SLE should be on HCQ as ‘background treatment’. While
on SLE, the Shanghai SLE meeting further confirmed the
efficacy of MMF not only in renal lupus but in most of the
serious complications of SLE [Chan TM. 8th Int Cong on
SLE; 2007; Shanghai, China]. Also, MMF has been shown
to be effective in systemic vasculitis [Ann Rheum Dis 2007;
66; 798]. Similarly it would seem that rituximab is effective
in most of the life threatening complications of SLE
[Tokunaga M et al. Ann Rheum Dis 2007; 66: 470].
RheumaPandit’s friends who treat osteoarthritis would
be delighted to read the paper by Christensen et al. [Ann
Rheum Dis 2007; 66: 433]. Just 0.25% reduction of body
weight every week for 5 months is all that is needed to
make the patient feel better. However, RheumaPandit’s
question” how to motivate a lazy, depressed, neglected, over-
weight elderly woman to lose weight?” On the osteoporosis
front RheumaPandit was made to believe that alendronate
was superior to the other oral bisphosphonates. A recent
paper says that risedronate bests alendronate for nonverte-
bral and hip fractures in the first year [Silverman SL, et al.
Osteoporos Int 2007; 18: 25]. RheumaPandit was reassured
about an earlier report on the efficacy of intra-lesional depot-
steroid injection for the treatment of carpal tunnel syndrome.
In a Cochrane review single local corticosteroid injection
was found to be the most effective way to avoid surgery in
severe carpal tunnel syndrome [Marshall S et al. Cochrane
Database of Systematic Reviews. 2007; 2: 1]. RheumaPandit
is glad that modes of treatment in alternative systems are
being scientifically analysed. Acupressure fails in this sci-
entific scrutiny [Manheimer E et al. Ann Intern Med 2007;
146: 868].
There are several additional interesting articles [On
amyloid treatment – NEJM 2007; 365: 2413; Why joints are
the target in RA – NEJM same issue p2419; Coxibs slow
down healing in postoperative period – J Bone Joint Surg
Am 2007; 89: 500] but space does not permit one to go on
and on! Happy reading.
Cheers!
RheumaPandit
***
Ann Intern Med 2007; 146: 621–39, 674–6.
Progressive and difficult to treat.
††
The leucopenia is a neutropenia.