Rheumatoid Arthritis

Exam Cram

• Commonest auto-immune cause of polyarthritis

• Presentation: 50F with poly-PIPJ arthralgia

• Diagnosis- clinical: ANA sensitive and antiCCP specific

• Management: 1. Prednisolone, 2. Methrotrexate

Felty syndrome: rheumatoid arthitis + splenomegaly + neutropenia [V common MCQ!!]

Outline

Background 

• Associated with: 

  • Increase in cardiovascular deaths- biggest source of increased mortality (x2)

  • ILD (Interstitial Lung Disease): lower lobe distribution and Bronchiectasis

Assessment

History:

• 50F with polyarthritis

• Poor response to NSAIDs

Examination:

• PIPJ & MTPJ swelling

• Swan neck deformity- late sign

• Maculopapular rash

Investigations

Sensitivity Specificity

• Rheumatoid Factor: 70% 50%

• anti-CCP: 75% 95%

• ANA:  90% 20%

• CRP/ ESR 80% 20%

• XR joints

Diagnosis

Diagnostic criteria: clinical

Differentials: 

• Sero +ve arthritis: Systemic Lupus Erythematous , Systemic Sclerosis, Sjogren's Syndrome 

• Sero -ve arthritis (PEAR): psoriatic, enteritis, ankylosing spondylitis, reactive arthritis

Management

1. Prednisolone

2. Methotrexate

3. Sulfasalazine

4. Etanercept (TNF antagonist)

Screen for Tuberculosis and HBV & HCV prior to starting etanercept. 

Med Reg Notes

Referral to Rheumatology

Rheumatoid arthritis outcomes are better with early aggressive interventions to prevent join destruction. Therefore suspicions of rheumatoid arthritis should result in prompt referral to Rheumatology, to start treatment before irreversible joint destruction occurs. 

Cardiovascular disease 

Increase rates of:

• Coronary artery disease

• Congestive heart failure- particularly HFpEF (diasytolic)

  • Constrictive pericarditis

References and Resources

1. https://cks.nice.org.uk/topics/rheumatoid-arthritis/

2. https://nras.org.uk/resource/diagnosis/

3. https://www.nhs.uk/conditions/rheumatoid-arthritis/diagnosis/

4. Crowson CS, Liao KP, Davis JM 3rd, Solomon DH, Matteson EL, Knutson KL, Hlatky MA, Gabriel SE. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013 Oct;166(4):622-628.e1. doi: 10.1016/j.ahj.2013.07.010. Epub 2013 Aug 29. PMID: 24093840; PMCID: PMC3890244. 

Page written in 2024.