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Rheumatoid arthritis

Last reviewed: 1 Nov 2023
Last updated: 20 Apr 2023

Summary

Definition

History and exam

Key diagnostic factors

  • active symmetric arthritis lasting >6 weeks
  • age 50 to 55 years
  • female sex
  • joint pain
  • joint swelling
More key diagnostic factors

Other diagnostic factors

  • morning stiffness
  • swan neck deformity
  • Boutonniere deformity
  • ulnar deviation
  • rheumatoid nodules
  • vasculitic lesions
  • pleuritic chest pain
  • scleritis and/or uveitis
Other diagnostic factors

Risk factors

  • genetic predisposition
  • smoking
More risk factors

Diagnostic investigations

1st investigations to order

  • rheumatoid factor (RF)
  • anticyclic citrullinated peptide (anti-CCP) antibody
  • radiographs
  • ultrasonography
More 1st investigations to order

Investigations to consider

  • disease activity score(s)
More investigations to consider

Treatment algorithm

ACUTE

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

ONGOING

failure to reach low disease activity after 3 months of therapy: not pregnant or planning pregnancy

Contributors

Authors

Yusuf Yazici, MD
Yusuf Yazici

Clinical Associate Professor of Medicine

New York University School of Medicine

New York

NY

Disclosures

YY receives research support from BMS and Genentech; he has consulted for Amgen, BMS, and Sanofi.

Peer reviewers

Chris Deighton, BMedSc, MD, FRCP

Consultant Rheumatologist

Department of Rheumatology

Royal Derby Hospital

Derby

UK

Disclosures

CD has received honoraria for talks at symposia sponsored by Wyeth and Abbott.

Raashid Luqmani, DM FRCP, FRCP(E)

Consultant Rheumatologist

Nuffield Orthopaedic Centre

Senior Lecturer in Rheumatology

Botnar Research Centre

University of Oxford

Oxford

UK

Disclosures

RL declares that he has no competing interests.

Alan Bridges, MD

Professor of Medicine

Section of Rheumatology

University of Wisconsin

Madison

WI

Disclosures

AB has received fees for speaking and consulting from Abbott, BMS, UCB, and Genentech.

John Kirwan, BSc, MB, BS, MD

Emeritus Professor of Rheumatic Diseases

School of Clinical Sciences

University of Bristol

Bristol

UK

Disclosures

JK declares that he has no competing interests.

Paul Emery, MA, MD, FMedSci

Professor of Rheumatology

Arthritis Research UK

Director

Leeds Institute of Rheumatic and Musculoskeletal Medicine

University of Leeds

Director

Leeds Musculoskeletal Biomedical Research Unit

Leeds Teaching Hospitals NHS Trust

Leeds

UK

Disclosures

Not disclosed.

Prabha Ranganathan, MD, MS

Associate Professor of Medicine

Division of Rheumatology

Washington University School of Medicine

St Louis

MO

Disclosures

PR declares that she has no competing interests.

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