Rheumatoid arthritis

Question 1

Rheumatoid arthritis presentation

Answer 1

• symmetrical polyarthritis
• joint pain, swelling, and stiffness
• often small joints (MCP, PIP)
• morning stiffness > 30 minutes
• fatigue, constitutional symptoms

Question 2

Rheumatoid arthritis investigations

Answer 2

• rheumatoid factor often positive
• anti-CCP - much more specific
• X-ray:
• loss of joint space
• juxta-articular osteoporosis
• soft tissue swelling
• periarticular erosions
• subluxation

Question 3

Rheumatoid arthritis differentials

Answer 3

• viral arthritis
• reactive arthritis
• psoriatic arthritis
• osteoarthritis
• polymyalgia rheumatica

Question 4

Rheumatoid arthritis management

Answer 4

• DMARD monotherapy, can have short course prednisolone
• methotrexate (monitor FBC, LFT)
• TNF inhibitor if poor response to 2 DMARDs, e.g. infliximab, etanercept (check for latent TB)