Rheumatoid Arthritis

Question 1

Rheumatoid arthritis

Answer 1

Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. An external trigger (e.g. cigarette smoking, infection, or trauma) triggers an autoimmune reaction, leading to synovial hypertrophy and chronic joint inflammation along with the prospect for extra-articular manifestations. It is believed to occur in genetically susceptible individuals and more common in middle aged women.

Question 2

Causes

Answer 2

Causes
y Unknown
y Autoimmune disorder
y Likely a combination of genetic and environmental factors

Question 3

Signs and Symptoms

Answer 3

Symptoms
y Joint stiffness
y Painful joints
y Swelling of affected joints y Deformity of affected joints y Limitation of motion
y Skin nodules
y Difficulty in breathing
y Easy fatiguability
Signs
y Persistent symmetric polyarthritis (synovitis) of hands and feet y Joint stiffness
y Joint tenderness
y Joint swelling
y Joint deformity
y Limitation of joint movement
y Rheumatoid nodules
y Signsrelatingtoextra-articularinvolvemente.g.lungdisease,uveitis,
pericardial or pleural effusions

Question 4

Investigations

Answer 4

Investigations
y FBC, ESR
y C-reactive protein level
y Rheumatoid Factor assay
y Antinuclear Antibody (ANA) assay
y Anti−Cyclic Citrullinated Peptide (Anti-CCP) y Joint aspiration and analysis of synovial fluid y Hepatitis B and C tests
y HIVtest
y X-rays of hands and feet
y MRI of cervical spine (to detect subluxation) y Ultrasonography of joints

Question 5

Treatment— page 555 STG

Answer 5

Treatment
Treatment objectives
y To reduce pain, swelling and stiffness
y To prevent deformities
y To delay disease progression and long-term complications y To reduce drug side effects
Non-pharmacological treatment
y Heat and cold therapies
y Orthotics and splints
y Physiotherapy
y Occupational therapy
y Adaptive equipment
y Joint-protection education y Couselling and education y Synovectomy
y Tenosynovectomy
y Tendon realignment
y Reconstructive surgery or arthroplasty y Arthrodesis

Answer 6

Referral Criteria
Refer all cases to a physician specialist or rheumatologist.