Home Forums Other Specialities Sports Medicine / Physical Medicine RHEUMATOID ARTHRITIS- BACK TO BASICS.

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      Anonymous
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      Rheumatoid Arthritis: A Protocol for Early Referral and DMARD Monitoring Guidelines

      Rheumatoid arthritis (RA) continues to offer a major management challenge: patients often present with non-specific, atypical symptoms.
      The diagnosis often cannot be confirmed or refuted with diagnostic tests, hence diagnosis is difficult. Other factors that might delay diagnosis include a lack of specialist clinics and rheumatologists.

      A major step forward in the past ten years has been the realisation that early treatment with disease-modifying anti-rheumatic drugs (DMARDs) is important if the disease process is to be slowed or halted.
      The rationale behind the early initiation of disease-modifying agents in RA is based on the recognition that joint damage occurs most rapidly early in the disease.
      Early referral is essential to reduce the inflammatory course and thus reduce the potential for joint damage.
      Referral to specialist clinics also enables patients to benefit from a holistic approach to the disease facilitated by the multidisciplinary team.

      Management goals

      Relief of symptoms
      Preservation of function
      Prevention of structural damage and deformity
      Patient education
      Maintenance of patient’s normal lifestyle

      Making a diagnosis

      Complete history and clinical examination/assessment of symptoms

      Morning stiffness, fatigue
      Synovitis of three or more joint areas
      Symmetric arthritis

      Remember:

      The pattern of joint involvement almost always favours the MCP and PIP joints/wrists
      The swelling on palpation is characteristic. Synovial swelling is soft unlike the hard, bony swelling in diseases like OA

      Differential diagnosis

      Other inflammatory arthritis, e.g. post viral
      Non-inflammatory joint conditions
      Connective tissue diseases
      Other important diagnoses, e.g. polymyalgic rheumatica

      Investigations

      Full blood count
      ESR/CRP
      Rheumatoid factor
      X-ray hands/feet (not necessary before referral)

      Dr G Mohan.

      If needed : Referral to Specialist-why,when and how ?
      Pharmacoligical approach?

      Can be requested from the author.

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