Rheumatoid arthritis

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

• Arthritis

Sources

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