Rheumatoid Arthritis Summary Overview: chronic, inflammatory symmetric polyarthritis involving small joints of hands/feet, knees, shoulders Signs & Symptoms: • early AM stiffness, >1 hour • sx improve with activity (inflammatory) • joint pain / swelling Physical Exam • synovitis; joint swelling or tenderness • joint deformities, rheumatoid nodules, joint effusions, reduced ROM Laboratory Studies • RF (rheumatoid factor) • anti-CCP (cyclic citrullinated peptide) - ↑ specificity than RF • ESR/CRP - ↑ inflammatory marker Imaging: • XRay (erosions, joint space narrowing) • Ultrasound Diagnosis: CLINICAL DIAGNOSIS based on history, exam and imaging Treatment: • steroids (prednisone), ideally limit for acute flare • intra-articular corticosteroid injections • DMARDs: Methotrexate (MTX), Sulfasalazine (SSZ), Hydroxychloroquine (HCQ), Leflunomide (LEF) • JAKi / Small Molecules: Tofacitinib, Baracitinib, Upadacitinib • Biologics: Anti-TNF (Adalimumab, Etanercept, Infliximab, Certolizumab, Golimumab), IL-6 (tocilizumab), Abatacept By Mithu Maheswaranathan, MD @MithuRheum via @RheumOnePagers #Rheumatoid #Arthritis #diagnosis #management #rheumatology
