🔺Rheumatoid Arthritis (RA) is a chronic systemic inflammatory condition affecting small and large joints in the body.
🔺Usually seen in both sides- small joints such as hands and feet etc
INCIDENCE
🔸1% of UK population can get RA
🔸Age- 30-50 years of age - peak onset , can peak at 70 as well
🔸Women 2-4 times > affected than men
🔸Can be associated with heart diease, infections, lymphomas etc
🔸Immediate family member with history of RA
COMPLICATIONS
COMMON ORTHOPAEDIC ISSUES
🔺Carpal tunnel syndrome
🔺Tendon ruptures
🔺Joint replacement surgery
🔺Neck related condition- ( cervical myelopathy)
🔺Fatigue/tiredness
🔺Weight loss
🔺Dry eyes
🔺Neuropathy
🔺Enlarged spleen
SYMPTOMS
🔺Painful and tender joints worse at rest and inactive time
🔺Morning stiffness > 1 hour usually for weeks
🔺Boggy swelling in the small joints
🔺Nodules are present in advanced cases on hands as shown
DIAGNOSIS
🔸Physical examination- squeeze tests for hands and feet
🔸Symptoms presentation as above
🔸Blood tests- not always positive, Rheumatoid factor ,Anti CCP antibodies , full blood count, liver and renal profile as well as CRP and ESR ( inflammatory markers)
🔸X-ray, Ultrasound and MRI- to check inflammation in the joints at various stages
🔸Referral should be made immediately when suspected of RA
MANAGEMENT
🔸Anti-inflammatories - Naproxen, celecoxib etc if suitable prescribed with stomach lining - protection omeprazole or lanzoprazole
🔸Treat to target strategy - to reduce the disease activity or achieve remission
🔸Rheumatology drugs- DMARDS, Biologics , Immnuoglobilins, boneprotection medicine discuss with specialist
🔸Monitor systemic symptoms- if any issues , contact GP for referral to see specialist
🔸Rheumatology follow ups are suggested to monitor the diease activity as discussed with specialist.
🔸Hydrotherapy, exercises to improve joint stiffness, splinting to improve hand function, see #physiotherapist for specialist advice
https://cks.nice.org.uk/topics/rheumatoid-arthritis/