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CNSLF Med - RA (ii) (Feet (often symm, usually affected a bit later, less…
CNSLF Med - RA (ii)
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Comorbidities
CVD: 2 fold increased risk, increased risk of death compared to general pop to screen + tx risk factors
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Infections: caution with high risk groups (steroid use, older age, longer disease duration, on combo DMARDs)
Cancer: increased risk of lymphoma, lung + certain skin cancers
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dDx
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postviral arthritis
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parvovirus, HBV, HCV, EBV, chikungunya
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seronegative arthritis
psoriatic arthritis
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check nails - pitting, dents, holes, white spots
check fingers - dactylitis (inflamm of entire finger, "sausage finger", can be painful)
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Dx criteria
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definition = presence of synovitis in @ least 1 joint which isn't better explained by another disease
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Screening for comps
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plain x-rays
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periarticular joint margin erosions seen in carpal bones, ulcer styloid, MCPs + MTPs
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Investigations
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bloods
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CRP (non-specific, indicates peaks + troughs of disease activity)
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autoabs
if both +ve indicates more severe (predicts more aggressive + erosive disease course) + worse prognosis
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RF
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60-80% sensitive, but low specificity
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