Rheumatoid Arthritis

Question 1

How does RA present?

Answer 1

Female age 30-50
Progressive peripheral and symmetrical polyarthritis
Usually affects MCP/PIP/MTP and spares DIP but can affect large joints
History >6 weeks
Morning stiffness >30mins

Question 2

What does examination in RA show?

Answer 2

Soft tissue swelling and tenderness

As it progresses - ulnar deviation, swan-neck and Boutonniere deformity, rheumatoid nodules

Question 3

What investigations are done in RA?

Answer 3

Rheumatoid factor and anti-CCP - not always positive
FBC - normocytic anaemia
Inflammatory markers (CRP and ESR) elevated

Question 4

What is the management of RA?

Answer 4

Initially DMARD monotherapy (methotrexate 2.5mg, hydroxychloroquine 200mg, sulfasalazine 500mg)
Steroids acutely (prednisolone)
Symptom control with NSAIDs
If disease severe after combination DMARDs consider biologics (anti-TNFs)

Question 5

What are the common extra articular manifestations of RA?

Answer 5

Carpal tunnel syndrome, elevated cardiac risk
Anaemia
Pleural disease, pulmonary disease
Sjogrens

Question 6

What are the x-ray features of RA?

Answer 6

Loss of joint space, erosions, soft tissue swelling, subluxation