RHEUMATOID ARTHRITIS (ADULT TYPE)

Systemic disease, of unknown aetiology, that is symmetrical, peripheral, and polyarthritic, most commonly involving the small joints of hands, wrists, metatarsophalangeal joints, ankles, knees, and cervical spine. This type is rare in children.

Clinical Features

  • Symmetrical peripheral polyarthritis mostly of small joints (warm, painful, stiff, swollen). Muscle wasting. Deformity, ulnar deviation, boutonniere deformity.
  • Extra-articular: Fever, weight loss, lassitude, anaemia, subcutaneous nodules, splenomegaly, lymphadenopathy, keratoconjuctivitis, pericarditis, pleuritis.
  • Complications: All the systems are involved in this disease.

Investigations

  • Haemogram – Moderate hypochromic, microcytic anaemia; or leucopaenia in Felty’s syndrome
  • ESR – Elevated
  • X-ray, especially hands and/or any other involved joint
  • Rheumatoid factor
  • Antinuclear antibodies

Management

  • Treat as outpatient:
    • Physiotherapy
    • Acetylsalicylic acid 75–100mg/kg/24 hour, maximum 600–900mg, 6 or 4 hourly preferably after food OR with antacid. Ibuprofen 30–50mg/kg/24 hour 6-8 hourly maximum 2,400mg/24 hour
  • Admit for:
    • Acute exacerbation
    • Bed rest (may need to splint the affected joint)
    • Intensive physiotherapy
    • Systemic complications
  • Refer if:
    • Deformities are present (seek surgical opinion).
    • Disease does not respond to NSAIDs.
    • There is systemic organ involvement requiring specialist intervention.