Difference between revisions of "Rheumatoid arthritis"

(Background)
(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
 
*[[Septic Arthritis (General)|Septic arthritis of previously injured joint]]
 
*[[Septic Arthritis (General)|Septic arthritis of previously injured joint]]
 
 
{{Differential Diagnosis Polyarthritis}}
 
{{Differential Diagnosis Polyarthritis}}
 +
{{Differntial Diagnosis Oligoarthritis}}
 +
{{Differencial Diagnosis Migratory Arthritis}}
  
 
==Evaluation==
 
==Evaluation==

Revision as of 19:00, 13 January 2021

Background

  • Rheumatoid arthritis is an autoimmune disease. It is an erosive polyarthritis that causes auto-antibodies direct against an individual's own joints and joint spaces.

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

Oligoarthritis

Migratory 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

See Also

References