Information about RA, including presentation, management, investigations and diagnosis
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Autoimmune condition causing synovitis of joints, tendon sheaths, and bursae
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Symmetrical and affects multiple joints
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3x more common in women
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Associated with HLA DR4 and HLA DR1
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70% of RA patients have +ve RF
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Some patients will be anti-CCP +ve
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More than 4/7 = diagnosis:
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Morning stiffness for >1hr for 6+ weeks
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3+ joints affected for 6+ weeks
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1+ joints in hand/wrist for 6+ weeks
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Symmetrical involvement of 1+ joints
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Presence of rheumatoid nodules
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High serum RF
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Consistent radiographic changes of hand or wrist
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Younger onset
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Male
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More joints + organs
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RF + anti-CCP
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Erosions on XR
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Key symptoms
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Symmetrical distal polyarthropathy
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Pain, swelling, stiffness
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Improves with activity
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Morning stiffness >1hr
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Systemic symptoms
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Fatigue
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Weight loss
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Flu
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Myalgia
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Caplan's syndrome - pulmonary fibrosis, pulmonary nodules
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Bronchiolitis obliterans
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Felty's syndrome - RA, neutropenia, splenomegaly
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Secondary Sjogren's syndrome - sicca syndrome
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Anaemia of chronic disease
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CVD
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Episcleritis and scleritis
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Rheumatoid nodules
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Lymphadenopathy
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Carpel tunnel syndrome
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Amyloidosis
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Methotrexate
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Pulmonary fibrosis
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Leflunomide
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HTN
Peripheral neuropathy |
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Sulfasalazine
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Male infertility (reduced sperm count)
Orange fluids |
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Hydroxychloroquine
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Nightmares
Reduced visual acuity |
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Anti-TNF medication
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Reactivation of TB or Hep B
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Rituximab
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Night sweats
Thrombocytopenia |
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PIP joints
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MCP joints
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Wrist + ankle
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Cervical spine
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Can involve large joints (knees, hips, shoulders)
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Does not involve DIP joints
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Self-limiting, short episodes of inflammatory arthritis
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Presents with joint pain, stiffness and swelling
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Episode lasts 1-2 days then completely resolves
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A +ve RF and anti-CCP can indicate it will progress to RA
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RF
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If -ve, check anti-CCP
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CRP + ESR
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XR of hands and feet
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USS to confirm synovitis
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Joint destruction and deformity
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Soft tissue swelling
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Periarticular osteopenia
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Bony erosions
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MDT
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Steroids
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Short course initially + flare ups
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NSAIDs (+PPI)
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DMARDs
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1. Monotherapy with methotrexate/leflunomide/sulfasalazine
Hydroxychloroquine if mild Take folic acid 5mg if on methotrexate |
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2. Dual therapy with above
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3. Methotrexate + biological therapy (usually TNF inhibitor)
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4. Methotrexate + rituximab
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If pregnant - sulfasalazine or hydroxychloroquine
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Surgery
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