RA Clinical Presentation & Diagnosis

Question 1

What are the signs and symptoms of RA?

Answer 1

Symetrical - inflammation, pain, tenderness, swelling. stiffness, redness & joint warmth
Progressive articular deterioration - LOF
General Symptoms - Weight los, fatigue, mental health changes
RA nodules

Question 2

What blood tests do you do for RA?

Answer 2

Erthrocyte sedimentation rate (ESR)
C-reactive proteins (CRP)
Rheumatoid Factor (RF)
Antinuclear Antibody (ANA)
Anti-cyclic citrunilated peptide (Anti-CCP)

Question 3

What is the NICE Guidelines on diagnosis of RA?

Answer 3

Referal - Primary care to specialist - refer those with suspected persistent synovitis.
Urgently if - Affecting small joints of hand & feet, more than 1 joint. Delay of >3months before seeking medical advice.
Diagnosis - If found to have synovitis on clinical examination - determin RF, Anti-CCP (if negative for RF), X-ray on hands and feet.

Question 3

What would you see on examination?

Answer 3

Lack of motion (Not able to form a fist)
Tenderness on palpitation (Squeeze test/metacarpelphalangal test)

Question 4

What is the DAS28 score?

Answer 4

A measure of Disease activity - 4 different measures.
- Number of swollent joints (Out of 28)
- Number of tender Joints (Out of 28)
- Meausre ESR/CRP
- Global assessment of health

Question 5

What does the different DAS28 scores mean?

Answer 5

DAS28 = >5.1 - Active disease
DAS28 = <3.2 - Low disease activity
DAS28 = <2.6 = Remission