What is rheumatoid arthritis ?
Rheumatoid arthritis is a long-term auto-immune condition which causes inflammation of our joints and often occurs in younger individuals.
Autoimmune means that; the immune system, our body’s defence system starts to attack specific joints as it mistakenly sees them as foreign dangerous. This results in pain, stiffness and swellings in the joints. The joints mainly affected are the ones in your hands, wrist and feet. It can also affect larger joints too.
What are the symptoms of Rheumatoid arthritis? (4)
- Pain which improves with exercise and is worse first thing in the morning
- Morning stiffness lasting longer than 1 hour
- Swollen/warm joints (in acute phase)
- Deformities
Name and describe the 5 deformities of Rheumatoid arthritis ? 😭
- Swan neck: hyperextension of DIPs and hyperextension of PIPs
- Boutonniere’s: hyperextension of PIPs and hyperextension of DIPs
- Z thumb: Hyperflexion of MCPs and Hyperextension of IPs
- Ulnar deviation
- Subluxation
What is the mnemonic for the clinical features of Rheumatoid arthritis?
ANTI-CCP Or RF
What are the clinical features of Rheumatoid arthritis? 😭
Arthritis: Symmetrical polyarthritis affecting PIPs and MCPs of hands and feet, but can also affect larger joints. DIPs are spared
Nodules: Firm, non tender, mobile/fixed nodules; commonly found on ELBOWs but also on heels and MCPs
Tenosynovitis: De Quervain’s Tenosynovitis;
Atlanto-axial subluxation of cervical spine
Immunology: Vasculitis, Amyloidosis: Affecting Kidneys: Nephrotic syndrome and Renal failure
Cardiac: Pericardial effusions and pericarditis
Carpal tunnel syndrome and peripheral neuropathy (Glove stocking pattern)
Pulmonary: Pulmonary Fibrosis; Fibrosing alveolitis and exudative pleural effusions
Ophthalmology: Episcleritis/Scleritis and Secondary Sjogren’s: Dry eyes and mouth
Raynaud’s
Felty’s Syndrome: RANS: RA, anaemia, Neutropenia and Splenomegaly
What are the investigations done for Rheumatoid arthritis with regards to the FF: 😭
Bloods (3)
Special bloods (3)
Imaging (1)
Bloods: FBC (Normocytic anaemia) increased WCC and platelets in acute disease), ESR and CRP (increased in acute disease)
Special bloods (3): Anti- CCP (98% specificity), RF +ve (70% +ve, but non-specific) and ANA +ve in 30%
Imaging (2): X-Ray: 2 Views
What are other forms of imaging
can be used for Rheumatoid arthritis ?
- USS and MRI
What is the mnemonic for the X-day features of Rheumatoid arthritis?
LPD S2
Describe the X-ray features of Rheumatoid arthritis
loss of joint space Periosteal erosions Deformities Soft-tissue swellings Subluxation
How will you manage someone who suspect is suffering with rheumatoid arthritis ?
If in GP, referral to Rheumatology for further assessment and treatment; explain the management
If in Hospital, Get Senior review and then explain the management
The management of Rheumatoid arthritis adopts a what approach ?
MDT approach
Describe the management with regards to the Ff:
- conservative (3)
- Medical (3) including the 2nd and 3rd Line treatment
- Surgery (3)
conservative: ROP: Rheumatology, OT and physiotherapist
- Medical: NSAIDs + Oral DMARDs; Methotrexate,
Steroids short-term and in acute disease: IM prednisolone
,2nd Line: 2 DMARDs
3rd Line: Biological agents
- Surgery: Synovectomy, Excision arthroplasty and Total joint replacement
what are the symptoms of Atlantoaxial subluxation of cervical spine and 2 Ix ?
Localised cervical pain and deformity
Ix: X-ray/CT C-spine
Examples of DMARDS (4)
methotrexate, sulphasalazine, hydroxychloroquine and leflunomide
Biological agents
anti-TNF and Anti B cell therapies
With regards to Rheumatoid arthritis treatment, how would you treat acute disease ?
Short course of oral prednisolone + methotrexate
For rheumatoid arthritis, if a patients condition is stable yet they continue to have pain. What should you prescribe ?
Paracetamol
