Chronic symmetric inflammatory polyarthritis of synovial joints with extra-articular features.
Clinical features
- • Symmetric small joint pain + early morning stiffness >1 h
- • MCP/PIP/wrist swelling
- • Fatigue, rheumatoid nodules
- • Extra-articular: ILD, vasculitis, anaemia, Sjögren
Investigations
- • RF, anti-CCP (more specific)
- • ESR/CRP
- • X-ray hands & feet (erosions, juxta-articular osteopenia)
- • USS / MRI synovitis
Diagnosis
- • ACR/EULAR 2010 criteria ≥6/10
Management
- • Early DMARD: methotrexate ± hydroxychloroquine ± sulfasalazine ± low-dose prednisolone bridge
- • Add biologic (anti-TNF, JAK inhibitor) if DAS28 >5.1 despite ≥2 DMARDs
- • Folic acid 5 mg weekly with methotrexate
Complications
- • Joint destruction, deformity
- • CVD (excess risk)
- • Infection on biologics
References
- • NICE NG100 RA 2018
Related in WardRound
Educational — verify locally.
