Rheumatoid Arthritis

Differential

• Systemic lupus erythematous
• Psoriatic arthritis
• Scleroderma
• Polymyalgia rheumatica
• Gout

Treatment

• Conservative
  • education, exercise, physical therapy, vaccinations, smoking cessation, and counseling
    • indication
      • a component of treatment for patients with rheumatoid arthritis
• Pharmacologic
  • disease-modifying antirheumatic drugs (DMARDs)
    • indications
      • used to prevent, stop, or retard disease-associated damage
    • medications
      • methotrexate 
        • typically the initial DMARD used
      • tumor necrosis factor (TNF) inhibitor such as 
        • etanercept
        • adalimumab
      • leflunomide
      • sulfasalazine
      • hydroxychloroquine 
  • nonsteroidal antiinflammatory drugs (NSAIDs) and/or glucocorticoids
    • indications
      • initially given for symptomatic control while waiting for DMARD response 
• Operative
  • joint replacement surgery
    • indication
• in patients with severe joint damage or failure to respond to conservative and medical therapy

Complications

• Hand deformities
• Atlantoaxial subluxation
• Popliteal cyst