{"id":4385,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatoidarthritis\/"},"modified":"2024-10-07T11:09:12","modified_gmt":"2024-10-07T10:09:12","slug":"rheumatoidarthritis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/rheumatoidarthritis\/","title":{"rendered":"Rheumatoid Arthritis"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\">History<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Joint pain stiffness and swelling in a symmetrical distribution affecting the wrists, MCP and PIP joints of the hands and MTP joints of the feet. Large joints may also be affected.<\/li>\n\n\n\n<li>Early morning stiffness (typically &gt;30min)<\/li>\n\n\n\n<li>Inactivity gelling (stiffness after a period of inactivity)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Examination<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Soft tissue swelling and tenderness of affected joints<\/li>\n\n\n\n<li>Pain on squeezing MCP and MTP joints (the squeeze test).<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Investigations<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC, ESR, LFT,<\/li>\n\n\n\n<li>Anti-CCP antibodies<\/li>\n\n\n\n<li>X-ray of the hands (periarticular osteoporosis, erosions)<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-light-accent-blue-background-color has-background\"><thead><tr><th><strong>JOINT DISTRIBUTION (0-5)<\/strong><\/th><\/tr><\/thead><tbody><tr><td><strong>1 large joint<\/strong><\/td><td><strong>0<\/strong><\/td><\/tr><tr><td><strong>2-10 large joints<\/strong><\/td><td><strong>1<\/strong><\/td><\/tr><tr><td><strong>1-3 small joints (large joints not counted)<\/strong><\/td><td><strong>2<\/strong><\/td><\/tr><tr><td><strong>4-10 small joints (large joints not counted)<\/strong><\/td><td><strong>3<\/strong><\/td><\/tr><tr><td><strong>&gt;10 joints (at least one small joint)<\/strong><\/td><td><strong>5<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-light-accent-blue-background-color has-background\"><thead><tr><th><strong>SEROLOGY (0-3)<\/strong><\/th><\/tr><\/thead><tbody><tr><td><strong>Negative RF <u>AND<\/u> negative ACPA<\/strong><\/td><td><strong>0<\/strong><\/td><\/tr><tr><td><strong>Low positive RF <u>OR<\/u> low positive ACPA<\/strong><\/td><td><strong>2<\/strong><\/td><\/tr><tr><td><strong>High positive RF <u>OR<\/u> high positive ACPA<\/strong><\/td><td><strong>3<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-light-accent-blue-background-color has-background\"><thead><tr><th><strong>SYMPTOM DURATION (0-1)<\/strong><\/th><\/tr><\/thead><tbody><tr><td><strong>&lt;6 weeks<\/strong><\/td><td><strong>0<\/strong><\/td><\/tr><tr><td><strong>\u22656 weeks<\/strong><\/td><td><strong>1<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-light-accent-blue-background-color has-background\"><thead><tr><th><strong>ACUTE PHASE REACTANTS (0-1)<\/strong><\/th><\/tr><\/thead><tbody><tr><td><strong>Normal CRP <u>AND<\/u> normal ESR<\/strong><\/td><td><strong>0<\/strong><\/td><\/tr><tr><td><strong>Abnormal CRP <u>OR<\/u> abnormal ESR<\/strong><\/td><td><strong>1<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>M.A &amp; S.R\/H.B. 25-01-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>When to refer:<\/strong> <\/h4>\n\n\n\n<p>Patients with swollen joints, significant morning stiffness. Refer for urgent appointment if scoring( above) is high.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway &gt; Rheumatology &gt; WGH<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Main differential diagnoses<\/h4>\n\n\n\n<p>Viral arthritis \u2013 Can present similarly but usually resolves within 4-6 weeks<\/p>\n\n\n\n<p>Osteoarthritis \u2013 The distribution is different (affects DIP, PIP and 1<sup>st<\/sup>&nbsp;CMC joints of the hands). There is bony joint swelling due to osteophytes. Levels of ESR and CRP are normal and CCP is negative.<\/p>\n\n\n\n<p>Psoriatic arthritis \u2013 the distribution is different and CCP is negative.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Initial management<\/h3>\n\n\n\n<p>Treat symptoms with NSAID \/ and or analgesics pending clinic review.<\/p>\n\n\n\n<p>Please avoid giving corticosteroids.<\/p>\n\n\n\n<p>If patient is very symptomatic or has systemic features please discuss with on-call team for an early appointment.<\/p>\n\n\n\n<p><strong>Please see Resources and links tab for additional information<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/versusarthritis.org\/about-arthritis\/conditions\/rheumatoid-arthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>https:\/\/versusarthritis.org\/about-arthritis\/conditions\/rheumatoid-arthritis\/<\/strong><\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/nras.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">NRAS | Rheumatoid arthritis charity<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>History Examination Investigations JOINT DISTRIBUTION (0-5) 1 large joint 0 2-10 large joints 1 1-3 small joints (large joints not counted) 2 4-10 small joints (large joints not counted) 3 &gt;10 joints (at least one small joint) 5 SEROLOGY (0-3) Negative RF AND negative ACPA 0 Low positive RF OR low positive ACPA 2 High<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[628],"class_list":["post-4385","page","type-page","status-publish","hentry","category-rheumatoidarthritis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/rheumatoidarthritis\/\" rel=\"tag\">Rheumatoid Arthritis<\/a>","rttpg_excerpt":"History Examination Investigations JOINT DISTRIBUTION (0-5) 1 large joint 0 2-10 large joints 1 1-3 small joints (large joints not counted) 2 4-10 small joints (large joints not counted) 3 &gt;10 joints (at least one small joint) 5 SEROLOGY (0-3) Negative RF AND negative ACPA 0 Low positive RF OR low positive ACPA 2 High","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4385","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4385"}],"version-history":[{"count":15,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4385\/revisions"}],"predecessor-version":[{"id":21132,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4385\/revisions\/21132"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4385"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4385"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}