Day 2- Rheumatoid Arthritis

Rheumatoid Arthritis

Evaluation (1987 Revised Classification Criteria)

• CRP and ESR (to identify inflammation)

• Rheumatoid factor (sensitivity of 70% and specificity of 70%) and anti-CCP (specificity of 98% and sensitivity of 80% for RA)

• CBC and lytes

• urinalysis (?Proteinuria ?RBCs or casts)

Physical Exam

• palpate MCP and PIP joints for synovial thickening or swelling

• feel for wrist thickening and tenderness

• examine elbows for flexion contracture

• MTP’s: squeeze ball of foot together to assess for soreness

Management

• counselling (can use disease and drug handouts from Rheuminfo)

• Use steroids for acute flare + DMARDs (classically MTX, sulfasalazine, hydroxychrloroquine)

  • confirm vaccinations prior to starting a DMARD and administer if necessary: herpes zoster, pneumococcal, influenza, hepatitis B and HPV

• Biologics can be considered

  • screen for TB and hep B and C first