Difference between revisions of "Rheumatoid arthritis"

(Differential Diagnosis)
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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==
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{{Differential Diagnosis Polyarthritis}}
 
{{Differential Diagnosis Polyarthritis}}
  
==Diagnosis==
+
==Evaluation==
*Xray affected joints
+
*Xray affected joints for erosions
*Rheumatoid factor
+
*Rheumatoid factor (positive in 60% to 70% of patients)
*Anti-cyclic citrullinated peptide (CCP) antibodies
+
*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
*[[Opiods]] have a limited role
+
*[[Opioids]] have a limited role
 
*Disease-modifying antirheumatic drug (DMARD)
 
*Disease-modifying antirheumatic drug (DMARD)
**Can be started by PMD or Rheumatologist after ER visit
+
**Can be started by primary care provider or rheumatologist after ER visit
  
 
==Disposition==
 
==Disposition==
*Refer to PMD or rheumatologist
+
*Discharge with referral to PCP or rheumatology
  
 
==See Also==
 
==See Also==
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==References==
 
==References==
 +
<references/>
  
[[Category:Rheum]]
+
[[Category:Rheumatology]]

Revision as of 15:51, 18 October 2019

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

Algorithm for Polyarticular arthralgia

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

See Also

References