RHEUMATOID ARTHRITIS

Symptoms : 

Joint pains > 6-12 weeks 

Swelling and Tenderness in Joints . 

Wrist joints and knuckles Variably 

Early morning stiffness

Fatigue 

Low grade fever 

SOB

Nodular swelling ( Rheumatoid Nodules) 

Diagnostic Work up 

CBC, ESR, PERIPHERAL SMEAR

COMPLETE URINE EXAMINATION

RENAL FUNCTION TESTS

LIVER FUNCTION TESTS

FBS, PLBS, HBA1C ( glycosated hemoglobin)

S. VIT.D, S.VIT B12, S.CA, S.LDH, S. FERRITIN

S.IL6& S.IL12 VALUES

CA-125, CEA, AFP, CA 19-9 

RA FACTOR IGG, IGM, 

ANTI-CCP, CRP, ASO TITRES 

CHEST XRAY 

XRAY BOTH HANDS AND WRISTS PA VIEW

USG OF BOTH HANDS AND WRISTS 

VIRAL SCREENING 

URINE C&S 

MANTOUX TEST 

USG ABDOMEN AND PELVIS 

HRCT CHEST & CT ABDOMEN WITH CONTRAST (SOS)

MRI FOR MONOARTICULAR ARTHRITIS 

ANA (IMMUNOFLUORESCENCE METHOD)

HLA B27 

TB IGRA / QUANT-GOLD 

ANCA(IMMUNOFLUORESCENCE METHOD)

SS(A)& SS(B) TITRES ( ANTI RO & LA)

TISSUE BIOPSY TO RULE OUT VASCULITIS 

DIFFERENTIAL DIAGNOSIS : 

STREPTOCOCCAL INFECTIONS 

MALIGNANCY 

POST VIRAL PHASE

UNTREATED UTI'S

DIABETES

HYPOTHYROIDISM

LEUKEMIAS 

TUBERCULOSIS

SARCOIDOSIS

VASCULITIS 

LUPUS

TREATMENT: 

NSAIDS & PAIN MANAGMENT

CORTICOSTEROIDS

DMARDS 

BIOLOGICS ( TNF ALPHA BLOCKADE& JAK2 INHIBITORS) 

CYTOTOXIC DRUGS