Difference between revisions of "Rheumatoid arthritis"

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Revision as of 02:38, 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

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