Most common form of chronic inflammatory joint disease affecting mainly women. Attacks tend to be bilateral with
symmetrical involvement that cause joint destruction.
Causes
- Unknown origin, probably autoimmune
Clinical features
- Stiffness and pain in the joints (usually >3, symmetrical, worse in the morning)
- Joints are swollen, warm, inflamed, and sensitive to touch
- Fingers are most affected (metacarpophalangeal, or proximal interpahalangeal), but all small and medium size
joints can be affected (rarely hips and spine) - Extra articular manifestations: mild fever, weakness, lethargy, anorexia, weight loss, rheumatoid nodules (20%) at extensor surface like forearm below joint
- It is a CHRONIC disease with flare-up, remission, and exacerbations
- In advanced cases, joint deformities may occur
Differential diagnosis
- Osteoarthritis, gout arthritis (in males)
- Reactive arthritis
Investigations
- Blood: Full blood count, ESR, rheumatoid factor, antinuclear factor
- X-ray of affected joints
Management
Goals of treatment
- Relief of symptoms
- Preservation of joint function
- Suppression of active disease, and slowing progression of disease (prevention of structure damage and deformity)
- Maintenance of patient’s normal lifestyle
Symptomatic treatment can be started at lower level but approprate management requires referral for specialist care.
For pain and inflammation in acute flare
- Rest the affected joints
- Any NSAIDS e.g. ibuprofen 400 mg every 8 hours
- Or diclofenac 50 mg every 8 hours
- Or indomethacin 50 mg every 8 hours
- Long term treatment is not advised because of toxicity, and because NSAIDS do not modify the
progression of disease - Consider adding gastroprotection with omeprazole 20 mg once daily
- Long term treatment is not advised because of toxicity, and because NSAIDS do not modify the
For severe acute inflammation
- Prednisolone 5–10 mg once daily in the morning
- They slow disease progression, but should not be used for long periods due to side effects
- Used for treating acute symptoms, and while waiting to start specific medicines
Refer to specialist for Disease Modifying Anti- Rheumatic Drugs
- Methotrexate
- Chloroquine
Counselling and health education
- Weight loss and appropriate exercise/ physiotherapy