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Rheumatoid Arthritis - Coggle Diagram
Rheumatoid Arthritis
Management Goals
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- Minimisation of inflammatory process
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- Prevent or control joint damage
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- PRevent extra-articular manifestations
Management
Early diagnosis and commencemnet of drug therapy is essential
DMARD as early as possible
Escalate dose / add 2nd line if needed
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Corticosteroids
Systemic steroids
- Efffective in relieving pain and stiffness
- Adverse effects frequent and severe
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Biologic Therapy
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Pre-Biological Screening
Bloods / Labs
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- Serology
Hep b / C
HIV
Varicella
Latent TB
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Analgesia
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- Paracetamol / codeine combination
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RA Diagnosis
- Clinical Diagnosis helped by lab/ radiology
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- Rheumatoid factor - less specific
- Anti-cyclic citrullinated (CCP) antibodies
90% specificity esp in high titre
ACR / EULAR 20110 criteria for diagnosis
Pt with early RA ay not fulfil these - tx should not be delayed
Seronegative RA
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Diagnosed with characteristic findings when other causes excluded
May not be possible to confirm diangosis in early disease course
Plain X ray
Hands, feet, other affected joints
- Peri-articular osteopenia
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Differential Diagnosis
Inflammatory
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- Spondyloarthropathies - Psoriatic arthritis
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- Crystal arthritis - Gout, CPPD
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Aetiology
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Family studies - siblings, twins
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Treatment Evidence
IF inflammatory process not stopped waith appropriate therapy, structural changes occur and lead to physical disability
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Clinical Features
Joint Manifestaions
- Pain / swelling of joints
- Typically symmetrical involvement of MCP, PIP joints of hands, wrists, MTP joints of feet - may have other patterns
- Morning stiffness - more than 1 hour suggests inflammatory arthritis
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Clinical Features
Signs
Hand Signs
Ulnar deviation of the fingers at the metacarpophalangeal (MCP) joints, due to chronic synovitis and ligamentous laxity.
Swan neck deformity, defined as hyperextension of the proximal interphalangeal (PIP) joint with flexion of the distal interphalangeal (DIP) joint.
Boutonnière deformity, which is flexion of the PIP joint with hyperextension of the DIP joint.
Z-thumb (Z deformity), characterized by hyperextension of the first MCP joint and flexion of the interphalangeal joint of the thumb.
MCP and PIP joint swelling and tenderness, often with fusiform (spindle-shaped) swelling centered on the joint, not the whole digit.[
Reduced grip strength, especially with synovitis of the first MCP joint.
Rheumatoid nodules (firm subcutaneous lumps), typically over extensor surfaces.
Joint subluxation and dislocation, especially in advanced disease.
Juxta-articular osteoporosis and bone erosions on imaging, most commonly at the MCP and PIP joints.
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