Rheumatoid Arthritis

Question 1

Typical patient

Answer 1

Women aged 30-50

Question 2

Symptoms

Answer 2

Greater than 6 weeks of:
Symmetrical painful, swollen, stiff peripheral joints. (MCPJ, PIPJ, Knee, Ankle)
Morning stiffness lasting longer than 30 mins.
Fatigue, Malaise, Loss of appetite.
Often associated with CTS

Question 3

Pathogenesis

Answer 3

Anti-CCP and Rheumatoid factor produce antibodies against self antigens.
Macrophages release TNF Alpha.
Proliferation of Synoviocytes causes swelling.
Synoviocyte proliferation reduces availability of nutrients for cartilage.
Osteoclast activity increased destroying bone.

Question 4

Examination

Answer 4

Pain, Redness, Swelling, Stiffness in effected joint.
Reduced ROM
Swann neck/ Boutonniere deformity
Ulnar deviation/ Palmar subluxation of MCP’s
Postive Tinnels/ Phalens Test
Rheumatoid Nodules

Question 5

Investigations

Answer 5

Anti CCP, RF
CRP
FBC (Anaemia of chronic disease)
WCC (Rule out septic arthritis)
X-Ray Joint
USS/MRI Joint
CXR

Question 6

Treatment

Answer 6

Hydroxychloroquine
NSAID’s PRN
Steroid bridge (Prednisolone 6wk)

Methotrexate

Biologics (Etanercept)

Physiotherapy, Psychosocial support