Rheumatoid arthritis: Difference between revisions

Revision as of 01:46, 25 January 2021

Rheumatoid arthritis is an autoimmune disease. It is an erosive polyarthritis that causes auto-antibodies direct against an individual's own joints and joint spaces.

Rheumatoid nodules on the extensor surfaces can develop in poorly controlled rheumatoid arthritis

Multiple swan neck deformity from poorly controlled rheumatoid arthritis

Morning stiffness
Polyarthritis of MCP and PIP joints
- Does NOT involve DIP joints
- Wrists, elbows, shoulders, ankles, knees also commonly involved
Ulnar deviation at MTP joints
Swan neck deformity
Rheumatoid nodules
Most patients initially diagnosed in the early 50s
Common associated conditions in severe cases: pleuritis, interstitial lung disease, pericarditis, inflammatory eye disease

Algorithm for Polyarticular arthralgia

Xray affected joints for erosions
Rheumatoid factor (positive in 60% to 70% of patients)
Anti-cyclic citrullinated peptide (CCP) antibodies (positive in about 70% of patients)
ANA
Consider arthrocentesis
- WBC count typically 1,500-20,000

NSAIDs
- Symptomatic relief without slowing underlying disease
Glucocorticoids
- Consider intraarticular injection if a single joint is inflammed
- Systemic steroids reserved for moderate-severe flairs
Opioids have a limited role
Disease-modifying antirheumatic drug (DMARD)
- Can be started by primary care provider or rheumatologist after ER visit

Authors:

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 ==Clinical Features==
 [[File:Rheumatoid_nodules.jpg|thumb|Rheumatoid nodules on the extensor surfaces can develop in poorly controlled rheumatoid arthritis]]
-[[File: swan neck deformity.jpg|thumb|Multiple swan neck deformities from poorly controlled [[rheumatoid arthritis]]]]
+[[File: swan neck deformity.jpg|thumb|Multiple [[swan neck deformities|swan neck deformity]] from poorly controlled rheumatoid arthritis]]
 *Morning stiffness
 *[[Polyarthritis]] of MCP and PIP joints