Rheumatoid arthritis RA

Rheumatoid arthritis
  • Facts:
    Sytemic autoimmune disorder
    Symmetric involvement of both large and small joints
    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
  • Treatment:
    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
    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)

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August 5th 2010