Rheumatoid arthritis

Chronic, erosive arthritis.
Etiology
Epidemiology F>M. Risk factors: smoking
Clinical presentation Active symmetrical arthritis >6/52
Rheumatoid nodules - over extensor surfaces of tendons, not necessarily over a joint. More likely if many joints involved.
See hand signs below
Pathogenesis
Diagnostic investigations RF, anti-CCP
Management NSAIDs for symptomatic relief
1st line: conventional DMARDs e.g. MTX, leflunomide, SSZ
Steroids may be used short-term to manage flares

non-joint signs

  • pericarditis

classic hand signs

  • ulnar deviation at MCPJs
  • Swan-neck deformity = PIPJ hyperextension, DIPJ flexion
  • Boutonniere's deformity = PIPJ hyperflexion, DIPJ hyperextension
    • Yes swan-neck and boutonniere are complete opposites
  • Z deformity of thumb