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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
Algorithm for Polyarticular arthralgia
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
