Print Friendly, PDF & Email
 
DEFINITION
Autoimmune conditions affecting the joints
 
CLASSIFICATION
 
a) Based on the number of joints with arthritis
  • Oligoarthritis-  4 or lesser joints within first 6 months

  • Persistent Arthritis- 4 joints or less affected throughout the disease process

  • Extended Arthritis- Affecting more than 4 joints after the first 6 months

  • Polyarthritis- 5 or more joints with arthritis in the first 6 months

 
b) Based on Rheumatoid factor
  • RF positive

  • RF negative

 
c) Other types
 

Systemic arthritis
Arthritis with or preceded by daily fever for at least 3 days with one or more of following

  • Erythematous rash

  • Lymphadenopathy

  • Hepatomegaly or splenomegaly 

  • Serositis

     

Psoriatic arthritis
Arthritis or Psoriasis with at least 2 of following
  • Dactylitis

  • Nail pitting

  • Psoriasis in the first-degree relative

 
Enthesitis-related arthritis
Arthritis or enthesitis with any 2 of following
  • Sacroiliac joint tenderness of inflammatory lumbosacral pain

  • HLA B27 antigen

  • Onset after age 6 years in a male

  • Acute (symptomatic) anterior uveitis

  • HLA B27-associated disease in a first-degree relative

 

SYMPTOMS

  • Pain, swelling and redness around joints.  

  • Stiffness in joints in the morning which lasts for more than 30 minutes

  • Fatigue 

 
HISTORY
Ask the following questions- 
  • Number of joints involved

  • Age at onset

  • Fever

  • Family history of psoriasis, eye conditions, inflammatory bowel disease, ankylosing spondylitis

 

EXAMINATION

  • Rash

  • Hepatomegaly/ splenomegaly

  • Lymphadenopathy

  • Psoriasis signs.

     

INVESTIGATIONS

These tests are used for classification of disease or establish activity of the disease

  • Full blood count

  • Erythrocyte sedimentation rate (ESR)

  • C-reactive protein (CRP)

  • HLA B27 

  • RF antibody

  • CCP Antibody

 

TREATMENT
 
No cure for rheumatoid arthritis
Medications used to reduce inflammation in the joints, relieve pain, prevent joint damage
  • NSAIDs are first-line treatment. Consider using a proton-pump inhibitor drug along with them

  • Methotrexate – takes 6-12 weeks to effect after commencing treatment

Remember- Baseline investigations are needed prior to the commencement of Methotrexate and require regular monitoring 

  • Leflunomide

  • Hydroxychloroquine

  • Sulfasalazine

  • Infliximab

 

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

three − one =