History questions- Joint pain
- Change in hair
- ELBOWS
- Rash
- Raynauds
- Visual changes
- Dry mouth or eyes
Seronegative RA
- RF negative
- ANA, ESR, CRP may still be abnormal
- Anti-CCP may be raised
- Common variant - 30% of patients
- Need to rely on clinical assessment - Disease activity score
Pregnancy
- Safe drugs
- Sulfasalazine
- Tramadol
- NSAIDs except in 3rd trimester
- Sjogren's/SLE
- Ro antibodies can cross placenta => Heart block
- => In utero scans + surgery
- Clotting in placenta => Growth retardation
Causes of raised ESR
- Myeloma
- Cancer
- Sjogren's
- TB
- Helminths (along with eosinophils)
- Lupus (do urine dip)
Adult-Onset Still's Disease (AOSD)
- Adult version of juvenile idiopathic arthritis
- Systemic inflammatory disease
- Classic triad:
- Persistent high spiking fever
- Joint pain
- Salmon-colored rash
- Raised ferritin, but no other abnormalities
- Prognosis is usually favorable but pulmonary, cardiovascular, and kidney manifestations may occasionally cause severe life-threatening complications
- Treated first with steroids such as prednisone
- Diagnosis requires 5 features, with 2 major:
| Major criteria |
Minor criteria |
| Fever of at least 39C for at least one week |
Sore throat |
| Arthralgias or arthritis for at least two weeks |
Lymphadenopathy |
| Nonpruritic salmon colored rash (usually over trunk or extremities while febrile) |
Hepatomegaly or splenomegaly |
| Leukocytosis ( 10,000/microL or greater), with granulocyte predominance |
Abnormal liver function tests |
|
Negative tests for antinuclear antibody and rheumatoid factor |
McMurray test - Rotation test for demonstrating torn cartilage of the knee
- A tear in the meniscus may cause a pedunculated tag of the meniscus which may become jammed between the joint surfaces
- Procedure:
- Knee is held by one hand, which is placed along the joint line
- Flex to complete flexion while the foot is held by the sole with the other hand
- Place one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress in order to identify a valgus deformity
- The other hand rotates the leg externally while extending the knee
- If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus
- Likewise the medial knee can be stabilized in a fully flexed position and the leg internally rotated as the leg is extended
Notes
- Psoriatic arthritis is typically asymetrical
- Swelling and tenderness of individual joints
- Frequently presents in a
pattern of monoarticular or oligoarticular joint involvement
- In
patients with multiple joints involved, the pattern lacks the symmetry
of rheumatoid arthritis
- Early psoriatic arthritis may involve just a few lower extremity joints, such as the knees
- PET scan for lymphoma/vasculitis
- Rheumatoid factor (RF) is found commonly in patients with systemic lupus erythematosus (SLE), and has been associated with a more benign disease course
- Enthesitis is inflammation of the entheses (sites where tendons or ligaments insert into the bone)
- 1st generation cephalosporins are great against Gram +ves but rubbish against Gram -ves
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