Rheumatoid Arthritis
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
Swan neck
Boutonnière
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?
Psoriatic arthropathy
Infection, bacterial, viral
Still disease
SLE
OA
What are the extra articular manifestations?
Occur in 30% of patients with RA
Lungs
Plural effusion
Plural nodules
Diffuse fibrosing alveolitis
Obstructive bronchiolitis
Vaculitis
Nail fold infarct
Cutaneous Vaculitis
Bowel infarction
Heart
Pericarditis
Aortic regurg
CNS
Mononuritis multiplux
Compressive arthropathy
Atlanto axial subluxation
Kidney
Amyloidosis
Eyes
Scleritis
Episcleritis
Scleromalasia perforance
Sicca syndrome
Spleen felty syndrome
How to investigate?
FBC
Inflammatory markers
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
Haemolytic anaemia
Pancytopenia secondary to felty syndrome
Bone marrow suppression secondary to treatment
What are the x ray finding?
Juxta articular osteoporosis
Loss of joint space
Bony erosion
Subluxation
Soft tissue thickening
What is the line of management?
NSAID’s
Control pain & stiffness
Act on cyclooxygenase pathway
DMD
Act through cytokines inhibition
Use early if sero +ve in presence of poor prognostic feature
Corticosteroids
Intra articular inj
Biologic
TNF inhibitors
What is the side effect of treatment?
NSAID’s
GI bleeding
Fluid retension
Interstitial nephritis
DMD
Methotrexate hepatotoxicity
Mouth ulcers
Bone marrow suppression
Pneumonitis
Sulphsalazine rash
Marrow suppression
Oligspermia
Biologics
Etarnecpt blood disorder
Reaction at the site of injection
Infleximab reaction of TB
What are the complications of RA?
Rupture tendon
Joint infection
Ruptured joint
Spinal cord compression
Amyloidosis
What are the types of presentations?
Palindromic
Transient
Remitting
Chronic persistant
Rapidly progressive
What are the poor prognostic features?
FR +ve
Extra articular feature
HLA DR4
Female
Early erosions
Insidious onset
Anaemia of old age
High inflammatory markers
read about RA new NICE guidelines Feb 2009
causes of occular involvement in RA:
ReplyDelete1-episcleritis/scleritis/scleromalcia
2-sjogren's syndrome
3-cataract secondary to steriods therapy
4-retinopathy secondary to chloroquine
5-extraocular muscle tendon synovitis
6-extraocular muscle paralysis secondary to penicilamine induced myaethenia
7-extraocular muscle paralysis secondary to mononuritis multiplex
causes of renal involvement in RA:
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cause of respiratory involvement in RA:
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treatment:
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