Clinically Suspect Arthralgia (CSA) Flashcards
What is clinically suspect arthralgia (CSA)?
A relatively newly defined pattern is that of clinically suspect arthralgia (CSA). In many patients, RA is preceded by a phase of articular symptoms that are present without clinically apparent synovitis. These complaints typically have an ‘inflammatory’ component for which the term CSA has been introduced. CSA is characterized by arthralgia of relative recent onset (< 1 year) and located in joints typically involved in RA, like the MCP joints. Symptoms are most severe in the morning with prolonged morning stiffness. If there is also no apparent other cause for arthralgia, like a systemic syndrome, CSA should be suspected. CSA patients are at risk to develop inflammatory arthritis and in particular RA, especially if autoantibodies such as rheumatoid factor or anti-citrullinated protein antibodies are present. Therefore, patients with CSA should be instructed of the clinical signs of arthritis and one may consider monitoring patients for signs of arthritis and progression to RA.
Is there any evidence for hydrotherapy in managing early arthritis?
Non-pharmacological interventions, such as dynamic exercises and occupational therapy, should be considered as adjuncts to drug treatment in patients with early arthritis.
The efficacy of non-pharmacological therapy has not been investigated in early arthritis and can only be extrapolated from the results of several RCTs in established RA.
Hydrotherapy in patients with RA has been evaluated in some studies, (Verhagen 2015, Hurkmans 2009) but with insufficient evidence to support a strong recommendation; consequently, hydrotherapy was not included in the current statement but may be considered at the individual patient level.
Is there any evidence for joint-specific dynamic exercises in early arthritis?
Previous RCTs have shown that joint-specific dynamic exercises may improve strength and physical function in RA, but the current SLR identified some controversial effects on disease activity. (Daien 2016, Hurkmans 2009).
Occupational therapy may improve functional ability and self-management but does not have a positive effect on disease activity; recent studies were not found. (Ekelman 2014).
Is there any evidence for diet in management of early arthritis?
Furthermore, the SLR did not identify appropriate trials that evaluated the effectiveness of diets.
What are some non-pharmacological recommendations for early arthritis management / prevention.
Prevention
In patients with early arthritis, smoking cessation, dental care, weight control, assessment of vaccination status and management of comorbidities should be part of overall patient care.
Why is the management of peridontal disease important in patients with RA?
RA is associated with periodontal disease, although the direction of the relationship remains unclear. (Fuggle 2016)
The microbiome may play a role in chronic arthritis risk and progression, and Porphyromonas gingivalis infection could promote aberrant citrullination and a local breach of tolerance to citrullinated peptides (Li 2022)
