Difference between revisions of "Rheumatoid arthritis"

(Differential Diagnosis)
(Clinical Features)
 
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==Background==
 
==Background==
*Erosive polyarthritis
+
*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]]
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[[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
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*[[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 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 athritis]]
+
*[[Septic Arthritis (General)|Septic arthritis of previously injured joint]]
*Osteoarthritis
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{{Differential Diagnosis Polyarthritis}}
*Viral arthritis
+
{{Differntial Diagnosis Oligoarthritis}}
*[[SLE]]
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{{Differencial Diagnosis Migratory Arthritis}}
*Psoriatic arthritis
 
*[[Lyme Disease]]
 
*Gonococcal arthritis
 
*[[Gout]]
 
*[[Pseudogout]]
 
*Juvenile idiopathic arthritis
 
*Fibromyalgia
 
  
==Workup==
+
==Evaluation==
*Xray affected joints
+
*Xray affected joints for erosions
*Rheumatoid factor
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*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
*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==
 
*[[Arthritis]]
 
*[[Arthritis]]
  
==Sources==
+
==References==
Up to Date
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<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

Rheumatoid nodules on the extensor surfaces can develop in poorly controlled rheumatoid arthritis
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

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