Rheumatology Book

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Rheumatoid Arthritis Diagnosis

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  1. See Also
    1. Rheumatoid Arthritis
    2. Rheumatoid Arthritis Articular Signs
    3. Rheumatoid Arthritis Extra-articular Signs
    4. Felty's Syndrome
    5. Rheumatoid Arthritis Management
    6. Rheumatoid Arthritis Antiinflammatory Medications
    7. Rheumatoid Arthritis Remittive Agents
  2. Pearls
    1. History and Examination are most important
      1. Symmetric involvement
      2. Morning stiffness and gelling
      3. Hand and wrist (esp. MCP joints) involvement
      4. Shaking hands is painful (withdraws hand on squeeze)
    2. Lab and x-ray add little help in diagnosis
      1. Erythrocyte Sedimentation Rate (ESR) may be normal
      2. C-Reactive Protein may be normal
      3. Rheumatoid Factor may be normal
      4. X-Ray may be normal
  3. Characteristics of onset
    1. Onset over weeks to months
    2. Prodromal symptoms of anorexia, weakness, Fatigue
    3. Usually starts in one joint
  4. ACR Rheumatoid Arthritis Diagnostic Criteria
    1. RA Diagnosis requires four of the following
    2. Symptoms that must be present for at least 6 weeks
      1. Morning stiffness in and around joints for >= 1 hour
        1. Most common presenting symptom
      2. Symmetric joint involvement
        1. Most common presenting sign
      3. Soft tissue swelling of at least three joint areas
        1. PIP joint
        2. MCP joint
        3. Wrist joint
        4. Elbow joint
        5. Knee joint
        6. Ankle joint
        7. MTP joint
      4. Swelling of mcp, pip or wrist joints
    3. Signs that may be present at any time
      1. Rheumatoid Nodules (subcutaneous Nodules) present
      2. Rheumatoid Factor positive
      3. X-ray changes
        1. See XRay Changes in Rheumatic Conditions
        2. Bone Erosions
        3. Periarticular Osteopenia (bone decalcification)
          1. Especially involving the hands and wrists
  5. Resources
    1. American College of Rheumatology (1987) RA Criteria
      1. http://www.rheumatology.org/research/classification

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