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Rheumatoid Arthritis -brief overview


🔺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/




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