Rheumatoid arthritis


  • Rheumatoid arthritis is an autoimmune disease. It is an erosive polyarthritis that causes auto-antibodies direct against an individual's own joints and joint spaces.

Clinical Features

  • Morning stiffness
  • Polyarthritis of MCP and PIP joints
    • Does NOT involve DIP joints
    • Wrists, elbows, shoulders, ankles, knees also commonly involved
  • Ulnar deviation at MTP joints
  • Swan neck deformity
  • Rheumatoid nodules
  • Most patients initially diagnosed in the early 50s
  • Common associated conditions in severe cases: pleuritis, interstitial lung disease, pericarditis, inflammatory eye disease

Differential Diagnosis



Migratory Arthritis


  • Xray affected joints for erosions
  • Rheumatoid factor (positive in 60% to 70% of patients)
  • Anti-cyclic citrullinated peptide (CCP) antibodies (positive in about 70% of patients)
  • ANA
  • Consider arthrocentesis
    • WBC count typically 1,500-20,000


  • NSAIDs
    • Symptomatic relief without slowing underlying disease
  • Glucocorticoids
    • Consider intraarticular injection if a single joint is inflammed
    • Systemic steroids reserved for moderate-severe flairs
  • Opioids have a limited role
  • Disease-modifying antirheumatic drug (DMARD)
    • Can be started by primary care provider or rheumatologist after ER visit


  • Discharge with referral to PCP or rheumatology

See Also


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