Rheumatoid arthritis: Difference between revisions
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Revision as of 13:10, 30 September 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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