Rheumatoid Arthritis
Brandon Grove, MD, and Heidi James, MD
Background
- Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of joints
- Red, hot, swollen, painful joints
- Can erode and deform over time
- Presents earlier than osteoarthritis (usually 20s to 40s)
- Can see juvenile RA
- Can see comorbid inflammatory diseases
- Rule out differential
- Osteoarthritis
- Gout/pseudogout
- Connective tissue disorders
- Viral arthritis
Clinical Findings
- Symptoms/signs
- Morning stiffness and pain improving with moderate use
- Fatigue or malaise
- Joints affected
- Proximal interphalangeal joints
- Metatarsophalangeal joints
- Wrists
- Ankles
- Knees
- Investigations
Management
- Rheumatology consult
- Early treatment with disease-modifying antirheumatic drugs (DMARDs)
- Methotrexate
- Plaquenil
- Cyclophosphamide
- Steroids
- Monoclonal antibodies
- Nonsteroidal anti-inflammatory drugs as needed for flares