RA Flashcards
What are the common examination findings?
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
What are the investigations?
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
What are the key investigation findings?
Bloods may be RF positive or CCP positive
X - RAy:
Joint space narrowing
Soft tissue swelling
Erosions
Subluxations
Subchondrol osteopenia
What is the treatment?
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
What are the risk factors?
Female
Smoker
FH