Chronic symmetrical inflammatory polyarthritis primarily affecting small joints, with extra-articular features.
Clinical features
- • Symmetrical small joint pain + swelling (MCP, PIP, MTP, wrist)
- • Early morning stiffness >1 h
- • Fatigue
Examination
- • Boggy synovitis
- • Ulnar deviation, swan neck, boutonnière
- • Rheumatoid nodules
Investigations
- • Anti-CCP (specific), RF
- • ESR, CRP, FBC
- • X-ray hands/feet (erosions, periarticular osteopenia)
- • USS / MRI for early synovitis
Management
- • Refer to rheumatology within 3 weeks
- • DMARD: methotrexate first-line ± hydroxychloroquine
- • Add biologic (TNFi, IL-6i, JAKi) if inadequate response
- • Bridging steroid
- • Treat-to-target: DAS28 remission
Complications
- • Joint destruction, deformity
- • Pulmonary (ILD, nodules)
- • Cardiovascular disease
- • Felty's, secondary amyloidosis
Clinical pearls
- • Methotrexate weekly + folic acid; monitor FBC, LFT
- • Screen for TB before biologics
Related in WardRound
Educational — verify locally.
