Chronic symmetrical inflammatory polyarthritis of synovial joints with systemic features and erosive potential.
Clinical features
- • Symmetrical small-joint pain and swelling (MCP, PIP, MTP)
- • Early morning stiffness >30 min
- • Fatigue and weight loss
Investigations
- • Rheumatoid factor and anti-CCP
- • CRP/ESR
- • X-ray hands and feet (erosions, periarticular osteopenia)
- • USS for subclinical synovitis
Management
- • Refer to rheumatology within 3 weeks of suspicion
- • Methotrexate plus short-term steroid bridge
- • Escalate to combination DMARDs or biologic if DAS28 >5.1 after 2 conventional DMARDs
- • Physio, OT and cardiovascular risk management
Complications
- • Joint destruction and deformity
- • Interstitial lung disease
- • Atlanto-axial subluxation
- • Accelerated atherosclerosis
- • Felty's syndrome
Clinical pearls
- • Ask about neck pain before intubation — atlanto-axial instability
- • Treat to target: remission or low disease activity
Related in WardRound
Educational — verify locally.
