Difference between revisions of "Rheumatoid arthritis"

(Differential Diagnosis)
(Differential Diagnosis)
Line 13: Line 13:
 
*[[Septic Arthritis (General)|Septic athritis]]
 
*[[Septic Arthritis (General)|Septic athritis]]
 
**Gonococcal arthritis
 
**Gonococcal arthritis
*Psoriatic arthritis
 
*[[Lyme Disease]]
 
 
*[[Gout]]
 
*[[Gout]]
 
*[[Pseudogout]]
 
*[[Pseudogout]]
*Fibromyalgia
 
  
 
{{Differential Diagnosis Polyarthritis}}
 
{{Differential Diagnosis Polyarthritis}}

Revision as of 06:19, 30 July 2015

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

Polyarthritis

Algorithm for Polyarticular arthralgia

Diagnosis

  • 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

References