Bilateral symmetrical arthropathy involving both hands
Spindling of the fingers due to swelling of the soft tissue at the MCJ and PIJ with sparing of the DIJ
Generalized wasting of the small muscles of the hand with wasting of the thenar and hypothenar eminence
There is deformity. Describe site
Z shaped deformity
There is subluxation at the MCP with ulnar deviation of the fingers
No evidence of sinovitis
No features of carpel tunnel syndrome
No palpable rheumatoid nodules at the elbow
There is marked functional disability of both hands
What is the differential diagnosis?
Infection, bacterial, viral
What are the extra articular manifestations?
Occur in 30% of patients with RA
Diffuse fibrosing alveolitis
Nail fold infarct
Atlanto axial subluxation
Spleen felty syndrome
How to investigate?
Serology RF +ve in 75 %
X ray of the affected joints
Aspiration if effusion is present
What are the causes of anaemia?
Anaemia of chronic disease
IDA secondary to NSAID’s
Pancytopenia secondary to felty syndrome
Bone marrow suppression secondary to treatment
What are the x ray finding?
Juxta articular osteoporosis
Loss of joint space
Soft tissue thickening
What is the line of management?
Control pain & stiffness
Act on cyclooxygenase pathway
Act through cytokines inhibition
Use early if sero +ve in presence of poor prognostic feature
Intra articular inj
What is the side effect of treatment?
Bone marrow suppression
Etarnecpt blood disorder
Reaction at the site of injection
Infleximab reaction of TB
What are the complications of RA?
Spinal cord compression
What are the types of presentations?
What are the poor prognostic features?
Extra articular feature
Anaemia of old age
High inflammatory markers
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