Rheumatoid arthritis: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
[[File:Rheumatoid_nodules.jpg|thumb|Rheumatoid nodules on the extensor surfaces can develop in poorly controlled rheumatoid arthritis]] | |||
[[File: swan neck deformity.jpg|thumb|Multiple [[swan neck deformity|swan neck deformities]] from poorly controlled rheumatoid arthritis]] | |||
*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 | *Ulnar deviation at MTP joints | ||
*[[Swan neck deformity]] | |||
*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 arthritis of previously injured joint]] | |||
{{Differential Diagnosis Polyarthritis}} | |||
{{Differntial Diagnosis Oligoarthritis}} | |||
*[[ | {{Differencial Diagnosis Migratory Arthritis}} | ||
== | ==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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==Management== | ==Management== | ||
*NSAIDs | *[[NSAIDs]] | ||
**Symptomatic relief without slowing underlying disease | **Symptomatic relief without slowing underlying disease | ||
*Glucocorticoids | *[[Glucocorticoids]] | ||
**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== | ||
*[[Arthritis]] | *[[Arthritis]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Rheumatology]] | |||
Latest revision as of 01:46, 25 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
Multiple swan neck deformities from poorly controlled rheumatoid arthritis
- Morning stiffness
- Polyarthritis of MCP and PIP joints
- Does NOT involve DIP joints
- Wrists, elbows, shoulders, ankles, knees also commonly involved
- Ulnar deviation at MTP joints
- Swan neck deformity
- 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
Oligoarthritis
- Ankylosing spondylitis
- Gonococcal arthritis
- Lyme disease
- Psoriatic arthritis
- Reactive arthritis
- Rheumatic fever
- Rheumatoid arthritis
- Systemic lupus erythematosus
Migratory Arthritis
- Gonococcal arthritis
- Lyme disease
- Rheumatic fever
- Systemic lupus erythematosus
- 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