Rheumatoid Arthritis (RA)

WHAT IS IT?

Rheumatoid arthritis (RA) is an inflammatory condition. 

WHAT CAUSES IT?

 

WHY IS IT CONCERNING MEDICALLY?

 

WHAT IS THE INTIAL PRESENTATION?

Patient Chief Complaints:

  • Arthritis (painful, swollen joints)

Detected Medical Problems:

 

WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

 

Medical History:

  • Morning stiffness: typically the symptoms of RA are worse in the mornings and improve throughout the day with use. 
WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Vital Signs:

  • Fever may be present in some patients 

Musculoskeletal Exam: many swollen painful joints may be present

  • Commonly affected joints of the hand:  PIP, MCP
  • Spared joints: the DIP joints of the hand are typically not involved. 
  • Ulnar deviation of hands can be a common findings 
  • Cervical spine involvement is common. 
CLINICAL WORKUP: SERUM STUDIES

General inflammation studies:

  • Elevated ESR
  • Elevated CRP
CLINICAL WORKUP: IMAGING

Classic X-Ray Findings:

  • Soft tissue swelling
  • Joint space narrowing
  • Bony erosions 
CLINICAL WORKUP: SEROLOGIES

The following serologies are characteristic of RA:

  • Positive rheumatoid factor 
  • Anti-CCP antibodies (anti-cyclic citruillnated peptide. 

 

HOW DO WE NARROW THE DIFFERENTIAL?

Conditions that present similarly and how to exclude them:

 

WHAT IS OUR THRESHOLD FOR DIAGNOSING THIS CONDITION?

 

PATIENT MANAGMENT: SYMPTOM RELEIF

 

PATIENT MANAGEMENT: DISEASE TREATMENT

 

PATIENT MANAGEMENT: PROPHYLACTIC MEASURES

 

COULD THIS HAVE BEEN PREVENTED?

 

ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

 

Page Updated: 05.07.2017