RA

Question 1

What are the common examination findings?

Answer 1

Hands:

Swelling and pain in MCP, PIP

Soft tissue swelling

Joint deformities:

Ulnar deviation/swan neck, boutenniere, z thumb, rheumatoid nodules

NB:

Wide range of associated symptoms with RA:

Lung - Effusions of fibrosis from treatment

Abdo - Splenomegaly (feltys)

Legs - E. nodosum or P.gangrenosum

Face - sjogrens

Question 2

What are the investigations?

Answer 2

To finish the exam i would like to - examine the joint above and below and perform a neurovascular exam if i havent already.

Also examine other systems commonly affected by RA

By the bed - History and obs and functional status

Bloods - FBC for anaemia of chronic disease, U/E for renal involement or damage secondary to meds, an bone profile to check for associated conditions.

ESR/CRP for inflammation

RF to rule out RA

Other - X ray of the joint

Question 3

What are the key investigation findings?

Answer 3

Bloods may be RF positive or CCP positive

X - RAy:

Joint space narrowing

Soft tissue swelling

Erosions

Subluxations

Subchondrol osteopenia

Question 5

What is the treatment?

Answer 5

Conservative - Explain what is is and about weight loss and a healthy diet, stay mobile, splints and walking aids

MDT - Physio, OT, GP, rheumatologist and other doctors if other symptoms

Medical - Steroids and DMARDS with PPI

Also biologics

Surgical - If persistant or unmanageable

Question 6

What are the risk factors?

Answer 6

Female

Smoker

FH