SALE. 20% off limited time only. Click here
image

Rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune disorder resulting in a symmetrical deforming polyarthropathy and various extra-articular features.

Risk factors

  • Female gender
  • Age 30-50
  • Genetic factors
  • Smoking

Clinical features

  • Polyarthritis
  • Morning stiffness
  • Tender, erythematous inflamed joints
  • Usually symmetrical
  • Any synovial joint can be affected
    • Mostly small joints (hands, feet, cervical spine)
    • MCP joints most commonly affected; DIP joints rarely affected
    • Cervical spine – odontoid peg erosion can result in fracture and atlanto-axial subluxation
  • Joint deformities
    • Loss of knuckle guttering
    • Swan neck deformity (PIP joint hyperextension + DIP joint flexion)
    • Boutonnière deformity (PIP joint flexion + DIP joint hyperextension)
    • Z-shaped thumb (IP joint hyperextension + MCP joint flexion)
    • Ulnar deviation
    • Palmar subluxation of MCP joints
  • Others, e.g. palmar erythema, small muscle wasting, reduced range of movement, carpal tunnel syndrome signs

Extra-articular features

image

Investigations

  • Bloods 
    • Raised inflammatory markers (ESR, CRP) 
    • Rheumatoid factor (autoantibody to Fc portion of IgG)
    • Anti-cyclic citrullinated peptide (CCP) – more specific
  • X-Rays

Management

  • NSAIDs: for symptomatic relief
  • Steroids: short course prednisolone at diagnosis to induce remission
  • Disease Modifying Anti-Rheumatic Drug (DMARD) therapy (e.g. methotrexate, leflunomide, sulfasalazine, hydroxychloroquine): commenced early to prevent long-term progression – monotherapy initially, with additional DMARD added if uncontrolled
  • Biologics (anti-TNFα, e.g. adalimumab, etanercept, infliximab; or anti-IL6, e.g. sarilumab): can halt or even reverse disease process; offered to patients with severe disease who have not responded to combination DMARDs 
  • Other therapies
    • Surgery: can improve mobility and reduce pain in patients with deformities
    • Physiotherapy
    • Occupational therapy

Questions

What are the classical features of rheumatoid arthritis on a radiograph?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

Which HLA genes are associated with inherited susceptibility to rheumatoid arthritis?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

Try some stations

  1. Hand and wrist exam
  2. Rheumatoid hand exam
  3. Rheumatoid arthritis viva
  4. Find more here!
image
Next
Gout
image
Join our email list!
For free OSCE tips and updates