Difference between revisions of "Rheumatoid arthritis"
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==Clinical Features== | ==Clinical Features== | ||
*Morning stiffness | *Morning stiffness | ||
| − | *Polyarthritis of MCP and PIP joints | + | *[[Polyarthritis]] of MCP and PIP joints |
**Does NOT involve DIP joints | **Does NOT involve DIP joints | ||
**Wrists, elbows, shoulders, ankles, knees also commonly involved | **Wrists, elbows, shoulders, ankles, knees also commonly involved | ||
*Ulnar deviation at the wrist | *Ulnar deviation at the wrist | ||
*Rheumatoid nodules | *Rheumatoid nodules | ||
| + | *Most patients initially diagnosed in the early 50s | ||
| + | *Common associated conditions in severe cases: pleuritis, [[interstitial lung disease]], [[pericarditis]], inflammatory eye disease | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| − | *[[Septic Arthritis (General)|Septic | + | *[[Septic Arthritis (General)|Septic arthritis of previously injured joint]] |
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| − | == | + | {{Differential Diagnosis Polyarthritis}} |
| − | *Xray affected joints | + | |
| − | *Rheumatoid factor | + | ==Evaluation== |
| − | *Anti-cyclic citrullinated peptide (CCP) antibodies | + | *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 | *ANA | ||
*Consider [[arthrocentesis]] | *Consider [[arthrocentesis]] | ||
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**Consider intraarticular injection if a single joint is inflammed | **Consider intraarticular injection if a single joint is inflammed | ||
**Systemic steroids reserved for moderate-severe flairs | **Systemic steroids reserved for moderate-severe flairs | ||
| − | *[[ | + | *[[Opioids]] have a limited role |
*Disease-modifying antirheumatic drug (DMARD) | *Disease-modifying antirheumatic drug (DMARD) | ||
| − | **Can be started by | + | **Can be started by primary care provider or rheumatologist after ER visit |
==Disposition== | ==Disposition== | ||
| − | * | + | *Discharge with referral to PCP or rheumatology |
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
| + | <references/> | ||
| − | [[Category: | + | [[Category:Rheumatology]] |
Revision as of 15:51, 18 October 2019
Contents
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
- Most patients initially diagnosed in the early 50s
- Common associated conditions in severe cases: pleuritis, interstitial lung disease, pericarditis, inflammatory eye disease
Differential Diagnosis
Polyarthritis
- Fibromyalgia
- Juvenile idiopathic arthritis
- Lyme disease
- Osteoarthritis
- Psoriatic arthritis
- Reactive poststreptococcal arthritis
- Rheumatoid arthritis
- Rheumatic fever
- Serum sickness
- Systemic lupus erythematosus
- Serum sickness–like reactions
- Viral arthritis
Evaluation
- 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
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
- Opioids have a limited role
- Disease-modifying antirheumatic drug (DMARD)
- Can be started by primary care provider or rheumatologist after ER visit
Disposition
- Discharge with referral to PCP or rheumatology