Rheumatoid arthritis (RA) is a chronic, erosive arthritis that requires early and aggressive treatment.
Diagnosed clinically. Laboratory and radiographic testing provide prognostic information more often than diagnostic information.
Early and aggressive treatment with disease-modifying anti-rheumatic drugs (DMARDs), potentially combined with a biological agent or a targeted synthetic DMARD, is recommended.
Disease activity scores (e.g., 28-joint count version of disease activity score [DAS28], clinical disease activity index [CDAI], simplified disease activity index [SDAI], routine assessment patient index data [RAPID3]) are used routinely to provide optimum care for RA patients.
Rheumatoid arthritis (RA) is a chronic inflammatory condition affecting around 1% of the population, making it the most common inflammatory arthritis seen by physicians. It primarily affects the small joints of the hands and feet and, if not treated aggressively, can be a major cause of work loss, decreased quality of life, need for joint replacement surgery, and mortality. RA is a clinical diagnosis; laboratory and radiographic tests help to confirm the diagnosis and provide useful prognostic information.
History and exam
Key diagnostic factors
- active symmetrical arthritis lasting >6 weeks
- age 50 to 55 years
- female sex
- joint pain
- joint swelling
Other diagnostic factors
- morning stiffness
- swan neck deformity
- Boutonniere's deformity
- ulnar deviation
- rheumatoid nodules
- vasculitic lesions
- pleuritic chest pain
- scleritis and/or uveitis
- genetic predisposition
1st investigations to order
- rheumatoid factor (RF)
- anti-cyclic citrullinated peptide (anti-CCP) antibody
Investigations to consider
- disease activity score(s)
mild disease activity at initial presentation: not pregnant or planning pregnancy
moderate-to-severe disease activity at initial presentation: not pregnant or planning pregnancy
pregnant or planning pregnancy
failure to reach low disease activity after 3 months of therapy: not pregnant or planning pregnancy
- Psoriatic arthritis (PsA)
- Infectious arthritis
- EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
- American College of Rheumatology guideline for the treatment of rheumatoid arthritis
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