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Rheumatoid OSCE, RA: Key Facts (Extra-Articular Features: aNTI CCP OR RF
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RA: Key Facts
Extra-Articular Features: aNTI CCP OR RF
- Nodules
- Tenosynovitis
- Immune
- Cardiac
- Carpal tunnel
- Pulmonary
- Ophthalmic
- Renal
- Raynaud’s
- Felty’s
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Immune
vasculitis, amyloidosis, Sjogren’s, AIHA
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Ophthalmic
episcleritis, scleritis, Sjogren’s
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Anti-CCP Abs
Cyclic Citrullinated Peptide
- Derived from collagen
- Citrullination of arginine 2O to inflammation
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Rheumatoid Hands
Systemic Examination
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BP and pulse
- ↑ risk of AF
- ↑ risk of cardiovascular disease
Eyes
- Epi-/scleritis
- Keratoconjunctivits sicca
- Anaemia
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Lungs
- Pulmonary fibrosis
- Percuss for effusions
- Pleural rub
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Hand Examination
Look
Hands
Skin: joint erythema, palmar erythema
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Muscle wasting: interossei, thenar eminence
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Presentation
- Symmetrical deforming polyarthropathy
- Signs of active synovitis
- Signs of cause
- Rheumatoid nodules
- Psoriatic plaques
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Viva
Mx
MDT: GP, physio, OT, rheumatologist, orthopod
Conservative
- Physio
- OT: aids and splints
Medical
- Analgesia
- Steroids: IM, PO or intra-articular
- DMARDS
- Biologicals
- reduce CV risk
- Prevention of PUD and osteoporosis
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Ix
Bloods
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Immune
- RF: +ve in 70%
- Anti-CCP: 98% specific, 75% sensitive
- ANA: +ve in 30%
- HLA-DR3/4
X-Ray
- Soft tissue swelling
- Periarticular osteopenia
- Loss of joint space
- Periarticular erosions
- Deformity
Hx
Symptoms
- Early morning stiffness
- Pain
- Swelling
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