Rheumatoid Arthritis (RA)

Last updated 30.03.13

Definition

-  Chronic systemic inflammatory AID effecting synovial membranes & joint articulations

 

Features

-  Women 3:1 men

-  Other AID

-  Onset 30-60 years

-  Symmetrical inflammatory polyarthritis

 

Cause

-  Autoimmune: lupus cluster

 

Dx

-  Morning stiffnes > 1 hour

-  Plus for > 6 weeks 4+ of:

-  3+ joint arthritis

-  Arthritis of hands, wrist, MCPs or PIPs

-  Symmetrical arthritis

-  Rheumatoid nodules

-  RF

-  X-ray changes

 

DDx

-  SLE: no joint erosions, reversible deformities

-  Polymyalgia Rheumatica

 

Associated S/S

-  Fatigue, malaise, fever, anorexia, weight loss

-  Anaemia, thrombocytosis

-  Joint deformities:

-  Boutonaaires, swan neck, z deformity

-  Ulnar deviation

-  Ankylosis

-  Arthritis mutilans

-  Synovitis: joint, pleuritis

-  Entrapment neuropathy: Carpal Tunnel Syndrome..

-  Pleural effusions

-  Sjogrens Syndrome (Sicca)

-  Xerostomia, keratoconjunctivitis sicca (red eye)

-  Feltys Syndrome

-  Splenomegaly, neutropaenia

   

Ix

-  FBE: anaemia, thrombocytosis

-  ESR/CRP

-  X-ray: joint erosions, deformities (as abve)

-  Autoimmune Screen: RF

 

Mx

-  Aspirin, NSAIDs, steroids

-  Corrective joint surgery

-  DMARD

-  Methotrexate

-  Infliximab (anti TNF)

 

 

References