Rheumatoid arthritis: Clinical (To be retired)


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Rheumatoid arthritis: Clinical (To be retired)

Medicine and surgery

Allergy and immunology

Antihistamines for allergies


Cardiology, cardiac surgery and vascular surgery

Coronary artery disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Syncope: Clinical (To be retired)

Hypertension: Clinical (To be retired)

Hypercholesterolemia: Clinical (To be retired)

Peripheral vascular disease: Clinical (To be retired)

Leg ulcers: Clinical (To be retired)

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Thiazide and thiazide-like diuretics

Calcium channel blockers

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Antiplatelet medications

Dermatology and plastic surgery

Hypersensitivity skin reactions: Clinical (To be retired)

Eczematous rashes: Clinical (To be retired)

Papulosquamous skin disorders: Clinical (To be retired)

Alopecia: Clinical (To be retired)

Hypopigmentation skin disorders: Clinical (To be retired)

Benign hyperpigmented skin lesions: Clinical (To be retired)

Skin cancer: Clinical (To be retired)

Endocrinology and ENT (Otolaryngology)

Diabetes mellitus: Clinical (To be retired)

Hyperthyroidism: Clinical (To be retired)

Hypothyroidism and thyroiditis: Clinical (To be retired)

Dizziness and vertigo: Clinical (To be retired)

Hyperthyroidism medications

Hypothyroidism medications


Hypoglycemics: Insulin secretagogues

Miscellaneous hypoglycemics

Gastroenterology and general surgery

Gastroesophageal reflux disease (GERD): Clinical (To be retired)

Peptic ulcers and stomach cancer: Clinical (To be retired)

Diarrhea: Clinical (To be retired)

Malabsorption: Clinical (To be retired)

Colorectal cancer: Clinical (To be retired)

Diverticular disease: Clinical (To be retired)

Anal conditions: Clinical (To be retired)

Cirrhosis: Clinical (To be retired)

Breast cancer: Clinical (To be retired)

Laxatives and cathartics


Acid reducing medications

Hematology and oncology

Anemia: Clinical (To be retired)

Anticoagulants: Warfarin

Anticoagulants: Direct factor inhibitors

Antiplatelet medications

Infectious diseases

Pneumonia: Clinical (To be retired)

Urinary tract infections: Clinical (To be retired)

Skin and soft tissue infections: Clinical (To be retired)

Protein synthesis inhibitors: Aminoglycosides

Antimetabolites: Sulfonamides and trimethoprim

Miscellaneous cell wall synthesis inhibitors

Protein synthesis inhibitors: Tetracyclines

Cell wall synthesis inhibitors: Penicillins

Miscellaneous protein synthesis inhibitors

Cell wall synthesis inhibitors: Cephalosporins

DNA synthesis inhibitors: Metronidazole

DNA synthesis inhibitors: Fluoroquinolones

Herpesvirus medications



Miscellaneous antifungal medications

Anti-mite and louse medications

Nephrology and urology

Chronic kidney disease: Clinical (To be retired)

Kidney stones: Clinical (To be retired)

Urinary incontinence: Pathology review

ACE inhibitors, ARBs and direct renin inhibitors

PDE5 inhibitors

Adrenergic antagonists: Alpha blockers

Neurology and neurosurgery

Stroke: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Headaches: Clinical (To be retired)

Migraine medications

Pulmonology and thoracic surgery

Asthma: Clinical (To be retired)

Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)

Lung cancer: Clinical (To be retired)

Antihistamines for allergies

Bronchodilators: Beta 2-agonists and muscarinic antagonists

Bronchodilators: Leukotriene antagonists and methylxanthines

Pulmonary corticosteroids and mast cell inhibitors

Rheumatology and orthopedic surgery

Joint pain: Clinical (To be retired)

Rheumatoid arthritis: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Anatomy clinical correlates: Bones, joints and muscles of the back

Anatomy clinical correlates: Hip, gluteal region and thigh

Anatomy clinical correlates: Knee

Anatomy clinical correlates: Leg and ankle

Anatomy clinical correlates: Foot

Acetaminophen (Paracetamol)

Non-steroidal anti-inflammatory drugs


Opioid agonists, mixed agonist-antagonists and partial agonists

Antigout medications

Osteoporosis medications


Rheumatoid arthritis: Clinical (To be retired)

USMLE® Step 2 questions

0 / 8 complete


USMLE® Step 2 style questions USMLE

of complete

A 62-year-old woman comes to the office because of pain in her hands for three years. She describes the pain as progressive - coming on slowly and worsening over the course of the three years. She says that her aunt and wheelchair-bound grandmother had problems with their hands as well. A hand X-ray is obtained which shows soft tissue swelling and marked juxta-articular osteopenia in her metacarpophalangeal and proximal interphalangeal joints, and minor bony erosions. Which of the following will most likely be present on her plain film ten years from now?


Content Reviewers

Rishi Desai, MD, MPH


Antonella Melani, MD

Evan Debevec-McKenney

Rheumatoid arthritis is a chronic inflammatory disorder that gradually affects synovial joints, but can also cause extra-articular disease as well. Rheumatoid arthritis has been linked to HLA-DR1 and HLA-DR4. Each time there’s a flare, there’s an increase in synovial and immune cells, and over time, that results in a thick, swollen synovial membrane with granulation tissue - called a pannus. The pannus can damage cartilage and other soft tissues and also erode bone. Typically, rheumatoid arthritis affects at least three joints, generally ones in the hands and feet. The disease tends to be symmetric, progressive, and over time it causes joint deformities like crooked fingers.

So the typical articular manifestations in rheumatoid arthritis are pain, swelling, and loss of mobility in the affected joints, but doesn’t usually cause redness or warmth because the inflammatory process is so gradual. Usually, there’s morning stiffness that improves after 30 minutes of movement. The most frequent sites of involvement are the proximal interphalangeal joints and metacarpo-phalangeal joints of the hand, whereas the distal interphalangeal joints is rarely involved because there’s very little synovium in that joint. When these joints are affected, it typically causes reduced grip strength.

In the feet, usually the metatarsophalangeal joints are affected, and it causes a person to bear more weight on the heels and hyperextend the toes. Other joints that can be involved are the wrists, elbows, shoulders, knees, and ankles. Hip involvement usually only happens later in the disease, and that can cause pain in the groin, thigh, or low back. One very dangerous spot is the C1-C2 joint, which is only synovial joint in the spine. When it’s affected it can cause neck pain, and if it’s not managed properly it can lead to spinal cord compression and tetraplegia.

The system inflammation in rheumatoid arthritis results in cytokines that can cause extra-articular symptoms. For example, cytokines can trigger fever, fatigue, and a loss of appetite that can eventually lead to weight loss. Rheumatoid arthritis can lead to vasculitis and specifically the formation of atheromatous plaques, which can lead to myocardial infarction and stroke. In fact, cardiovascular disease is the primary cause of mortality associated with rheumatoid arthritis. In skeletal muscle, cytokines cause muscle breakdown, and in the skin they lead to the formation of rheumatoid nodules over bony prominences. Rheumatoid nodules are round collections of macrophages and lymphocytes that have a central area of necrosis. In the liver, lots of hepcidin is made and that causes decreased iron absorption in the intestines, and allows iron to get trapped in the macrophages - leading to lower serum iron levels. In the lung, fibroblasts get activated, causing pulmonary fibrosis, and the pleural lining gets inflamed, leading to pleural effusions.


Rheumatoid arthritis (RA) is a systemic inflammatory disorder of autoimmune origin that is primarily characterized by progressive, symmetric joint destruction, especially in the wrists and fingers, but may also affect other joints and many organs, such as the skin, heart, blood vessels, and lungs. Symptoms of RA include fatigue, joint pain, stiffness, and swelling, which can lead to decreased range of motion and joint deformity. RA is a chronic condition and treatment is focused on managing symptoms and preventing further joint damage. Treatment options include medications such as non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs) and biologic agents, physical therapy, and in some cases, surgery.


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