Rheumatoid Arthritis

More documents

Recommendations

Info

Recommendations to improve quality of careRecommendation 1Differentiate inflammatory from non-inflammatory arthritisFEATURE INFLAMMATORY NON-INFLAMMATORYJoint pain With activity and at rest With activityJoint swelling Soft tissue BonyJoint deformity Common CommonLocal erythema Sometimes AbsentLocal warmth Frequent AbsentMorning stiffness >30 minutes 30 minutes• Painful swelling of 3 or more joints• Involvement of hands and feet (especially MCP and MTP joints)• Duration of 4 or more weeksDifferential diagnoses include: crystal arthropathy, psoriatic arthritis, lupus, reactive arthritis,spondyloarthropathies.N.B. Always consider infectionFeatures suggesting alternative diagnosis include• Mucosal ulcers, photosensitivity, psoriasis, skin rashes• Raynaud’s• Ocular inflammation• Urethritis• Inflammatory bowel disease• Infectious diarrhea• Nephritis• Isolated distal interphalangeal (DIP) jointsIt should be noted that extra-articular manifestations are an indication of more severe disease andthus have prognostic value. Established RA may have extra-articular manifestations including:CUTANEOUS OCULAR PULMONARY CARDIAC NEUROLOGICAL HEMATOLOGICAL• Nodules • Sicca • Pleuritis • Pericarditis • Peripheral neuropathy • Leukopenia• Vasculitis • Episcleritis • Nodules • Atherosclerosis • Cervical myelopathy • Anemia of chronic• Scleritis • Interstitial lung • Myocardial diseasedisease infarction • Lymphadenopathy• FibrosisRheumatoid Arthritis: Diagnosis and Management
Recommendation 3TestingRA is a clinical diagnosis. There are no tests that are completely reliable in making the diagnosis.Tests are primarily used to monitor the disease or exclude other types of arthritis.TESTS DIAGNOSTIC VALUE DISEASE ACTIVITY MONITORING COST (as of 2005)ErythrocyteSedimentation Rate(ESR) or C-ReactiveProtein (CRP)Rheumatoid Factor(RF)AntinuclearAntibody (ANA)Indicate only inflammatory process- very low specificityRF has low sensitivity and specificityfor RA. Seropositive RA has a worseprognosis than seronegative RA.Positive in cases with severe RA,systemic lupus erythematosus (SLE)or other connective tissue disorders(CTD).Most patients with positive ANA donot have RA, SLE, or CTD.Negative ANA usually excludes SLE.Often useful. ESR elevated in manybut not all with active inflammation.May be useful in monitoring diseaseactivity and response to treatment.ESR $2.46CRP $24.94No value $11.49No value - do not repeat $33.40X-RaysDiagnostic erosions rarely seen indisease of
Page 1: Rheumatoid Arthritis: Diagnosis and
Page 5 and 6: References and Resources:1. Guideli
Page 7 and 8: Rheumatoid ArthritisA Guide for Adu

Rheumatoid Arthritis

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?