Rheumatoid arthritis RA

• Facts:
  Sytemic autoimmune disorder
  Symmetric involvement of both large and small joints
  HLA-DR4
  DIP joints rarely involved
• History / PE:
  Morning stiffness
  Boutonniere deformity
  Keratoconjunctivitis sicca (Sjogren's)
  Atlantoaxial subluxation (intubation risk)
• Diagnosis:
  Increase in RF seen in 75% of cases
  Increase ESR
  ACD
  
• Treatment:
  NSAIDs
  DMARDs (initiate as soon as diagnosis of RA is made)
  TNF inhibitors (infliximab, etanercept)
• Complications:
  Osteopenia, osteoporosis
  Septic arthritis
• Notes:
  Axial skeleton rarely involved, but when it does occur, see CERVICAL spine involvement (neck pain, stiffness, hyperreflexia, C1-C2 instability subaxial subluxation)
• Associated With:
  Felty's syndrome
  Sjogren's syndrome
  Amyloidosis
  Osteoporosis
  Baker cyst
• Differential Diagnosis:
  Osteoarthritis (worse with movement, DIP involvement)
  Viral (Parvovirus B19) arthritis
  SLE arthritis (anti-dsDNA)
  RF arthritis (polymigratory)
  Mixed connective tissue disease (anti nRNP)