rheumatoid arthritis

symmetric, inflammatory, peripheral polyarthritis

Causes deformity through stretching of tendons/ligaments and destruction of joints through erosion of cartilage and bone

>6 weeks duration, if acute think viral

Osteopenia/Osteoporosis- immobility and drug-induced

Muscle Weakness- inflammation and drug-induced myopathies

Skin Disease- rheumatoid nodules, ulcers

Eye involvement- mostly dryness

Lung Disease- drug-induced or 2/2 disease

Cardiac Disease- pericarditis, myocarditis, CAD, HF, A fib

Non-cardiac valvular disease-PAD, vasculitis, CVA

Kidney Disease- rare glomerulonephritis

Sjogren's syndrome- ocular and oral dryness

Neurologic/Psychiatric disease- carpal tunnel, depression

Hematologic abnormalities- Anemia, neutropenia

Altered Body composition- increased fat and decreased muscle

RF and anti-CCP positive test increases overall sensitivity, both tests negative in up to 50% of patients and remain negative in 20% on follow up. Repeat in 6-12 mo

ESR and CRP typically elevated

ANA to rule out SLE and other rheumatologic disease

CBC often shows anemia and thrombocytosis due to chronic inflammation

Liver and kidney function normal

Normal Uric Acid

Radiographs of hands/wrists/feet to monitor disease progression

Inflammatory arthritis involving 3+ joints

Positive RF and/or anti-CCP

Elevated CRP or ESR

Diseases with similar clinical features have been excluded

Duration of symptoms more than 6 weeks

Treat initial symptoms with NSAIDS or glucocorticoids

Early intervention with DMARDs- either non-biologic (MTX, HCQ, SSZ, LEF) or Biologics

Treat flares with intraarticular or systemic steroids