MANUAL MINORS
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes persistent synovial inflammation, primarily affecting the small joints of the hands and feet. It is characterised by pain, swelling, prolonged morning stiffness, and progressive joint erosion, which can lead to deformity and disability. RA typically presents symmetrically and is associated with systemic manifestations such as fatigue, low-grade fever, and extra-articular involvement (lungs, eyes, skin).
Diagnosis
Diagnosis is based on clinical signs of symmetrical polyarthritis, morning stiffness lasting more than an hour, and physical examination findings such as joint swelling and tenderness. It is confirmed with laboratory tests, including the detection of rheumatoid factor (RF) and anti-CCP (anti-cyclic citrullinated peptide) antibodies, both of which are present in most RA patients.
Elevated inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are common. X-rays may show bone erosions and joint space narrowing in advanced stages.
Differential Diagnosis
Condition | Distinctive Features |
|---|---|
Osteoarthritis | Chronic, non-inflammatory joint pain, no prolonged stiffness, and no symmetrical involvement of small joints. |
Systemic lupus erythematosus | Multisystem involvement, positive serological tests (ANA, anti-DNA), malar rash. |
Gout | Acute attacks, urate crystals in synovial fluid, usually monoarticular. |
Psoriatic arthritis | Associated with psoriasis, asymmetrical involvement, typically affecting distal finger joints. |
Reactive arthritis | History of prior infection (urinary or gastrointestinal), asymmetrical, primarily affects the lower limbs. |
Emergency Management
Emergency treatment focuses on pain and inflammation control. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to alleviate symptoms, and in some cases, oral or intra-articular corticosteroids may be administered to reduce acute inflammation.
If the patient experiences a severe flare-up, hospitalisation may be required to adjust their baseline treatment. In emergencies, the possibility of severe joint damage or systemic involvement, such as pulmonary or cardiovascular complications, must be evaluated and may require immediate intervention.
Definitive Treatment
Definitive treatment for rheumatoid arthritis involves the use of disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, leflunomide, or sulfasalazine, to slow disease progression.
Biological agents, including TNF inhibitors or interleukin inhibitors, are used in cases of severe or refractory RA. Management should be multidisciplinary, with physiotherapy and rehabilitation to maintain joint mobility and prevent long-term disability.
Comments