Rheumatoid arthritis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Polyarthritis | *Morning stiffness | ||
*Polyarthritis of MCP and PIP joints | |||
**Does NOT involve DIP joints | |||
**Wrists, elbows, shoulders, ankles, knees also commonly involved | |||
*Ulnar deviation at the wrist | |||
*Rheumatoid nodules | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Septic athritis | *Septic athritis | ||
*Osteoarthritis | *Osteoarthritis | ||
*Viral arthritis | |||
*[[SLE]] | *[[SLE]] | ||
*Psoriatic arthritis | *Psoriatic arthritis | ||
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*[[Gout]] | *[[Gout]] | ||
*[[Pseudogout]] | *[[Pseudogout]] | ||
*Juvenile idiopathic arthritis | |||
*Fibromyalgia | |||
==Workup== | ==Workup== | ||
*Xray affected joints | *Xray affected joints | ||
*Rheumatoid factor | *Rheumatoid factor | ||
*Anti-cyclic citrullinated peptide (CCP) antibodies | |||
*ANA | |||
*Consider [[arthrocentesis]] | *Consider [[arthrocentesis]] | ||
**WBC count typically 1,500-20,000 | |||
==Management== | ==Management== | ||
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**Symptomatic relief without slowing underlying disease | **Symptomatic relief without slowing underlying disease | ||
*Glucocorticoids | *Glucocorticoids | ||
**Consider intraarticular injection if a single joint is inflammed | |||
**Systemic steroids reserved for moderate-severe flairs | |||
*Opiods have a limited role | *Opiods have a limited role | ||
*Disease-modifying antirheumatic drug (DMARD) | *Disease-modifying antirheumatic drug (DMARD) | ||
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==See Also== | ==See Also== | ||
*[[Arthritis]] | *[[Arthritis]] | ||
==Sources== | ==Sources== | ||
Up to Date | Up to Date | ||
Revision as of 00:14, 26 March 2014
Background
- Erosive polyarthritis
Clinical Features
- Morning stiffness
- Polyarthritis of MCP and PIP joints
- Does NOT involve DIP joints
- Wrists, elbows, shoulders, ankles, knees also commonly involved
- Ulnar deviation at the wrist
- Rheumatoid nodules
Differential Diagnosis
- Septic athritis
- Osteoarthritis
- Viral arthritis
- SLE
- Psoriatic arthritis
- Lyme disease
- Gonococcal arthritis
- Gout
- Pseudogout
- Juvenile idiopathic arthritis
- Fibromyalgia
Workup
- Xray affected joints
- Rheumatoid factor
- Anti-cyclic citrullinated peptide (CCP) antibodies
- ANA
- Consider arthrocentesis
- WBC count typically 1,500-20,000
Management
- NSAIDs
- Symptomatic relief without slowing underlying disease
- Glucocorticoids
- Consider intraarticular injection if a single joint is inflammed
- Systemic steroids reserved for moderate-severe flairs
- Opiods have a limited role
- Disease-modifying antirheumatic drug (DMARD)
- Can be started by PMD or Rheumatologist after ER visit
Disposition
- Refer to PMD or rheumatologist
See Also
Sources
Up to Date