INFLAMMATORY DISEASES (CLINICALS) Flashcards
What are the signs and symptoms of RA?
Pain, swelling, stiffness (especially upon waking and can last for more than 30 minutes), fever, weight loss, redness and joint warmth.
What are the tests done to diagnose RA?
Blood tests;
- Erythrocyte sedimentation rate (ESR) and CRP
- Rheumatoid factor: 30% of RA patients do not have this.
- Antinuclear antibody (ANA): 40% of patients have it.
- Anti-cyclic citrullinated peptide: specific for RA
- Radiology; you see the inflammation but when it is early stage that may not be seen.
On examination; you can squeeze the hand slightly and if there is a sign of gel or sometimes pain then it is characteristic of RA.
According to the NICE guidelines for investigations and diagnosis of RA, offer to carry out a blood test for rheumatoid factor in adults with suspected RA who are found to have synovitis on clinical examination. Consider measuring the anti-CCP antibodies in adults with suspected RA but test negative for rheumatoid factor. X-rays the hands and feet in adults with suspected RA and persistent synovitis.
What are the important factors to consider when diagnosing RA?
No one test will provide a diagnosis. it is dependent on complete history taking, clinical presentation and investigations.
-During history taking: ask about morning stiffness and mostly the morning stiffness is greater than 30 minutes, family history and lifestyle.
- Investigations: check for inflammatory markers, haematological parameters, immunological parameter and radiological investigations.
- Clinical presentations: symmetrical effects on synovial joints as symptoms discussed.
What are the monitoring for RA?
- DAS 28 with scores > 5.1 showing high activity disease, < 3.2 showing low activity disease, < 2.6 being remission.
Appropriate management of early therapy shows
- improvement in symptoms
- Reduce mortality
- Improves function
- May reduce comorbidities
What are the aims of treatment in RA?
- Minimising joint pain and swelling
- Preventing deformity and radiological damage (ie erosion)
- Maintaining quality of life
- Controlling extra-articular manifestations.