RHEUMATOID ARTHRITIS

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

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