MEDICAL INSIDER
DR CORA LIM
FOR MAY 28, 2023
Applied Rheumatology Made Simple (A.R.M.S.)
(Part 9 )
Let us go to RHEUMATOID ARTHRITIS (RA).
What information are included here? They are: Chronic
inflammatory synovitis, Potentially disabling polyarthritis, Female
predilection and May have extra-articular/systemic manifestations.
In contrast to osteoarthritis (OA) which starts off as a cartilage
problem, rheumatoid arthritis is predominantly a synovitis, with the
participation of several inflammatory cells and mediators such as
cytokines, forming a sheet of inflammatory reaction with fibrosis,
called pannus.
ACR 1987 CLASSIFICATION CRITERIA FOR RHEUMATOID
ARTHRITIS . . . . Requires four out of the seven criteria:
- Morning stiffness
- Arthritis of three or more joints
- Arthritis of hand joints
- Symmetric arthritis
- Rheumatoid nodules
- Serum rheumatoid factor
- Radiographic changes
“Must have been present for at least six weeks
Let us remember that disease-modifying anti-rheumatic drugs or
DMARDs are a mainstay in the management of RA. These are
primarily instituted by a specialist: The role of the primary care
physician is to monitor and recognize side-effects of the individual
drugs.
ACR guidelines in RA treatment – I: It is fundamental to establish
the diagnosis of RA. NSAIDs constitute the first line of therapy,
even while observing the patient prior to the required 6 weeks
duration of symptoms for RA diagnosis. Patient education and
physical therapy are important adjuncts in the treatment.
ACR guidelines in RA treatment – II: With persistent active
disease, it is best to refer to the rheumatologist, who will reassess
the patient and likely start a DMARD ora combination of
DMARDs. The patient may be endorsed back to the primary care
physician (usually for proximity reasons) for monitoring of
response to and any adverse effects of therapy.
ACR guidelines in RA treatment – III: This phase of the algorithm
largely involves the specialist, and ‘illustrates the unpredictability
of RA, with some patients proving refractory to therapy. It also
reiterates the team approach to the RA patient, with the
physiatrist and surgeon among other health professionals, also
involved in the total management of the patient.
There are what we call as the CHRONIC RHEUMATIC
DISEASES SOME “RA VARIANTS:
- Ankylosing spondylitis
- Psoriatic arthritis
What are the procedures in the REHABILITATION of CHRONIC
ARTHRITIS? - Rest-local, systemic
- Exercise – passive, active, strengthening, endurance, stretching,
aquatics, recreational - Heat and cold modalities
- Orthotics and assistive devices
- Self-care
- Education
What constitutes the CLINICAL PRESENTATION OF SLE-I? - Constitutional – fever, fatigue
- Musculoskeletal – arthritis, myositis
- Mucocutaneous – oral ulcers, rashes, alopecia
- Reticuloendothelial – lymphadenopathy
- Neuro-psychiatric disorder
- Serositis – pericardial or pleural effusion, ascites
What constitutes the CLINICAL PRESENTATION OF SLE-II?
Syndromes - Nephritis/Nephrotic syndrome
- Idiopathic thrombocytopenic purpura
- Autoimmune hemolytic anemia
- Fever of undetermined origin
- Rheumatoid arthritis
- Undifferentiated connective tissue disease