Inflammatory Arthritis

Question 1

Differential diagnosis for joint pain swelling

Answer 1

Rheumatoid arthritis
Osteoarthritis
Gout
Psoriatic arthritis
Septic arthritis
Seronegative spondyloarthropathies

Question 2

Investigations

Answer 2

X-ray of hands and feet
Rheumatoid factor + Anti-CCP
Ultrasound = synovitis
Bloods = ESR, CRP,
Joint Aspiration = bacteria for septic, crystals

Question 3

Management of RA

Answer 3

FIRST LINE: DMARD = METHOTREXATE + folate
SECOND LINE: Add another DMARD = SULFASALAZINE or HYDROXYCHLOROQUINE
GOLD STANDARD = DMARD + BIOLOGIC = METHOTREXATE + INFLIXIMAB (FL) or RITUXIMAB (SL)
Treat flares:
- NSAIDS
- Intra-articular therapy: glucocorticoids = IM Methylprednisolone

Question 4

Professionals involved in care for RA Px

Answer 4

Consultant rheumatologist
General practitioner (GP)
Hand therapist
Neurologist
Occupational therapist
Orthopaedic surgeon
Orthotist
Physiotherapist