Rheumatoid arthritis
Incidental findings Cushingoid
+ve signs ‘Symmetrical deforming polyarthropathy’, swelling MCP, PIP, wasting small muscles, ulnar deviation fingers, boutonierre, swan neck, Z thumb, nail fold infarcts, nodules
Differential diagnosis RA, Psoriasis
Function
Tests FBC – anaemia, hypersplenism
LFTs – methotrexate s/e
RF
Extensions

  • Chest for fibrosis, pleural effusion
  • Abdomen for splenomegaly (Felty’s, 2° amyloidosis)
  • Peripheral neuropathy, carpal tunnel
Notes

  • Other features: subluxation MCP joint, subluxation ulna at carpal joint, scleritis, episcleritis
  • 5 causes anaemia: (i) Anaemia chronic disease (ii) NSAID induced GI bleeding (iii) Bone marrow supression due to methotrexate (iv) Associated pernicious anaemia (v) Felty’s
  • Rx: Exercise; Physio; NSAIDs; DMARDs (methotrexate, sulphasalazine, chloroquine); corticosteroids; anti-TNF
  • Indications etanercept/infliximab: ≥ 3 swollen joints and ≥ 3 painful joints and failure of two previous DMARDs (given on own or together)
  • Methotrexate side effects: Hepatic fibrosis, pneumonitis, cytopenia
  • Boutonierre deformity: disruption of central slip of extensor tendon
‹ PsoriasisupSystemic sclerosis / CREST ›
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Submitted by SANTOSH CHAUBEY (not verified) on Mon, 2007-09-17 11:24.

I think D/D of Deforming symmetrical polyarthropathy also includes Jaccoud's arthritis and intests CXR is useful in RA to look for Interstitial changes. infection ( immunosuppresionn related) cardiac size as Hyperetension/valve path etc associated with RA can cause Cardiomegaly and IHD is the Most common cause of death in RA

*****Your notes are fantastic and very comprehensive.

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