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Rheumatoid Arthritis (Investigation (Erythrocyte sedimentation rate (ESR)
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Rheumatoid Arthritis
Investigation
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FBC: infection, inflammation, anaemia
X-ray: 1st choice to establish a baseline from which to measure disease progression or response to therapy. Erosions are found earlier in the feet than in the hands
Serum rheumatoid factor (RF) level: part of the current classification criteria, RF level is tested at baseline to establish diagnosis
Synovial fluid analysis: rule out other causes of inflammatory arthritis, such as septic arthritis, gout
Management
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Methotrexate: reduces inflammation, is the most common first-choice agent
Clinical features
Hx
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any mechanical joint problems, such as loss of motion, instability, misalignment, and/or deformity?
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Physical examination
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ulnar deviation, boutonniere and swan-neck deformities, hammer toes
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Definition: systemic autoimmune disorder classically presenting as symmetric polyarthritis affecting the small joints of the and feet hands (not distal interphalangeal joints), and sometimes larger joints such as the wrists, ankles, shoulders, and knees
Diagnosis of RA is likely with a score of 6 or higher
Joint involvement:
:red_flag: One large joint = 0
:red_flag: Two to ten large joints = 1
:red_flag: One to three small joints (with or without involvement of large joints) = 2
:red_flag: Four to ten small joints (with or without involvement of large joints) = 3
:red_flag: More than 10 joints (and at least one small joint) = 5
Serology (at least one test result is needed for classification):
:red_flag: Negative RF and negative anti-CCP antibodies tests = 0
:red_flag: Low-positive RF or low-positive anti-CCP antibodies test = 2
:red_flag: High-positive RF or high-positive anti-CCP antibodies test = 3
:red_flag: Acute-phase reactants (at least one test result is needed for classification):
:red_flag: Normal C-reactive protein level and normal erythrocyte sedimentation rate (ESR) results = 0
:red_flag: Abnormal C-reactive protein level or abnormal ESR result = 1
Duration of symptoms:
:red_flag: Fewer than 6 weeks = 0
:red_flag: Longer than or equal to 6 weeks = 1