Difference between revisions of "Rheumatoid arthritis"

(Created page with "==Background== *Erosive polyarthritis ==Clinical Features== *Polyarthritis ==Differential Diagnosis== *Septic athritis *Osteoarthritis *SLE *Psoriatic arthritis *Lyme ...")
 
(new note)
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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