5. Inflammation of joints tendons and bursae.
Early morning stiffness > 1 hour which eases with
physical activity.
Symmetrical small joints of hands and feet are
involved may be mono, oligo or polyarticular.
6. Wrists, MCP and PIP are frequently involved joints.
TRIGGER FINGER (flexor tendon synovitis)
ULNAR DEVIATION (subluxation of MCP joint)
SWAN NECK DEFORMITY (flexion of DIP joint,
hyperextension of PIP joint)
BOUTONNIERS DEFORMITY (flexion of PIP joint,
hyperextension of DIP joint)
Z-LINE DEFORMITY OF THUMB (flexion of 1ST MCP,
hyperextension of 1st IP joint)
11. Most common cause of death
is Cardio vascular disease.
Osteoporosis is commonly
seen.
Hypoandrogenism.
12. Epidemiology = 0.5 – 1% of adult population.
First degree relative = 2-10 times more than normal.
HLADRB1 gene .
13. ACR AND EULAR CLASSIFICATION
CRITERIA SCORE
JOINT INVOLVEMENT
1 LARGE JOINT 0
2-10 LARGE JOINTS 1
1-3 SMALL JOINTS 2
4-10 SMALL JOINTS 3
>10 SMALL JOINTS 5
SEROLOGY
RF & ACPA negative 0
RF or ACPA slightly positive 2
RF or ACPA highly positive 3
APR
CRP & ESR negative 0
CRP or ESR increased 1
DURATION
<6 weeks 0
>6 weeks 1
Score >= 6 is
definite RA
14. Rheumatoid factor (RF)
RF is positive in many cases :-
RA
SLE
Sjogren’s Syndrome
Polymyositis/ dermatomyositis
RF is positive in Non Rheumatic condition as well :-
Viral infections e.g hepatitis
T.B , Leprosy, Syphilis
Chronic Liver disease
Elderly
Relative of patients with RA
15. RF has prognostic value and is positive in 70 percent
of cases.
Anti CCP is more specific than RF.
Joint fluid evaluation shows 2000-5000 wbc per mm
cube, wheras in septic arthritis it exceeds this value.
16. Treatment
REST
DMARDS
Methotrexate 7.5mg/week with folic acid 1mg/day
(can be increased upto 30mg/week and LFT, Chest Xray,
Blood count is necessary every month)
TAB. ONCOTREX 7.5MG
Hydroxychloroquinine 200-400mg/day (eye checkup)
Sulfasalazine 500mg/day (can be increased upto 2-
3gm/day) TAB. SAZO EN 500mg
Leflonomide10-20mg/day (TAB. ARAVA)
17. Treatment
Steroids
In acute phase tab. Prednisolone 40-60mg/day for 2-4
weeks and taper down.
If for longer duration then 5-10mg/day.
Intrarticular injections.
BIOLOGICAL DMARDS/ ANTI CYTOKINE AGENTS
Infliximab
Etanercept
SYNOVECTOMY/ PHYSIOTHERAPY