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Rheumatoid Arthritis

Rheumatoid Arthritis  

Felipe Martínez

in Chest Imaging

Print Publication Year: 
Jul 2019
Series: 
Rotations in Radiology
Published Online: 
Aug 2019
eISBN: 
9780199392636
DOI: 
10.1093/med/9780199858064.003.0059
Career: 
Doctor, Qualified, early specialism training, Qualified, late specialism training, Qualified, specialist
Specialty: 
Radiology, Clinical Radiology, Clinical Medicine, Respiratory Medicine and Pulmonology
Item type: 
chapter
ISBN: 
9780199858064
Caplan syndrome (i.e., RA in the setting of coal worker’s pneumoconiosis). ■ Pleural and pericardial disease: Pleural thickening and effusions are the most common thoracic manifestations of RA with a prevalence of up to 70%, but imaging findings are nonspecific ( Fig. 59.8 ). ■ Osseous changes: Symmetric erosions in the distal clavicles and humeral heads may provide a helpful clue to the diagnosis of pulmonary involvement by RA ( Fig. 59.9 ). ■ Large airway involvement: There are cricoarytenoid abnormalities in up to 75% of patients with RA due to the presence
Diagnosis and clinical features of rheumatoid arthritis

Diagnosis and clinical features of rheumatoid arthritis  

Raashid Luqmani, Maarten Boers, and Theodore Pincus (eds)

in Rheumatoid Arthritis (Oxford Rheumatology Library)

Print Publication Year: 
Feb 2010
Series: 
Oxford Medical Libraries, Oxford Rheumatology Library
Published Online: 
May 2011
eISBN: 
9780191740213
DOI: 
10.1093/med/9780199556755.003.0003
Career: 
Nurse, Qualified Nurse, Doctor, Qualified, early specialism training, Qualified, late specialism training, Qualified, specialist
Specialty: 
Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780199556755
lymphadenopathy. Often it is impossible to distinguish polymyalgia rheumatica from polymyalgic onset RA – some authors have suggested that PMR is a form of rheumatoid factor-negative RA . In practice, it is usual to institute treatment for PMR (typically 10–15 mg per day prednisolone.) If, despite improvement in their systemic symptoms, the patients develop small joint pain and swelling, this suggests that the diagnosis was actually “polymyalgic–onset” RA . A diagnosis of RA is reinforced by finding that the patient has a positive rheumatoid factor test, or ACPA, if available
Rheumatoid Arthritis and Spondyloarthropathies

Rheumatoid Arthritis and Spondyloarthropathies  

Kerry Wright and Lynne S. Peterson

in Mayo Clinic Internal Medicine Board Review (12 edn)

Print Publication Year: 
Oct 2019
Series: 
Mayo Clinic Scientific Press
Published Online: 
Oct 2019
eISBN: 
9780190938406
DOI: 
10.1093/med/9780190938369.003.0083
Career: 
Doctor, Undergraduate Doctor, Qualified, early specialism training, Qualified, late specialism training
Specialty: 
Clinical Medicine
Item type: 
chapter
ISBN: 
9780190938369
microbiome is likely another source for citrullination. In RA , a breakdown occurs in the person’s tolerance toward these citrullinated proteins, leading to production of anti–citrullinated protein antibodies (ACPAs). The antibodies are distinct to RA and can occur 3 to 7 years before the RA diagnosis . Epitope spreading (the development of antibodies against similar molecules) and increased cytokine production gradually increase the person’s autoimmunity until RA disease becomes apparent. Early RA Microbial or mechanical insults have been proposed as damaging
Case 24

Case 24  

Joel David, Anne Miller, Anushka Soni, and Lyn Williamson

in Oxford Case Histories in Rheumatology

Print Publication Year: 
Oct 2011
Series: 
Oxford Case Histories
Published Online: 
Nov 2012
eISBN: 
9780191753442
DOI: 
10.1093/med/9780199587506.003.0024
Career: 
Doctor, Qualified, early specialism training, Qualified, late specialism training
Specialty: 
Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780199587506
enhancement pattern. Questions 1. Give a differential diagnosis at her initial presentation with joint pains. 2. What are the current recommendations for management of rheumatoid arthritis ( RA )? 3. What are the causes of shortness of breath in RA ? Give a differential diagnosis based on the CXR findings. 4. What is the differential diagnosis for the endomyocardial inflammation or fibrosis? 5. What are the current NICE guidelines for starting biological therapy in RA ? The patient had a coronary angiogram which was normal, excluding an ischaemic
Making a diagnosis of psoriatic arthritis

Making a diagnosis of psoriatic arthritis  

Dafna D. Gladman, Cheryl F. Rosen, and Vinod Chandran

in Psoriatic Arthritis (Oxford Rheumatology Library)

Print Publication Year: 
Apr 2014
Series: 
Oxford Medical Libraries, Oxford Rheumatology Library
Published Online: 
Apr 2014
eISBN: 
9780191743108
DOI: 
10.1093/med/9780199692095.003.0007
Career: 
Doctor, Qualified, early specialism training, Undergraduate Doctor
Specialty: 
Clinical Medicine, Rheumatology, Dermatology
Item type: 
chapter
ISBN: 
9780199692095
in RA ( Figure 7.1 ). If a patient with polyarthritis and psoriasis has a rheumatoid nodule, it is most likely that they have RA and psoriasis. Rheumatoid nodules should not occur in patients with PsA. On the other hand, if a patient has evidence of dactylitis, or enthesitis, they are more likely to have PsA than RA . The presence of axial disease, based on inflammatory back or neck pain and stiffness and radiographic evidence of sacroiliitis or syndesmophytes, again points to the diagnosis of PsA rather than RA . A clinical feature which helps differentiate RA with
Rheumatoid Arthritis

Rheumatoid Arthritis  

Derrick J. Todd and Jonathan S. Coblyn

in The Brigham Intensive Review of Internal Medicine

Print Publication Year: 
Jul 2014
Series: 
Other
Published Online: 
Jul 2014
eISBN: 
9780191742620
DOI: 
10.1093/med/9780199358274.003.0023
Career: 
Doctor, Qualified, late specialism training, Qualified, specialist
Specialty: 
Clinical Medicine, Primary Care
Item type: 
chapter
ISBN: 
9780199358274
patients with RA . Laboratory Testing No single laboratory test should be used to diagnose RA in the absence of clinical findings. Laboratory studies are used to support the diagnosis of RA in a patient with suggestive symptoms, to monitor RA disease activity, and to rule out other possible causes of arthritis. Serum rheumatoid factor (RF) testing is highly useful in the diagnostic workup of patients with polyarthritis, as approximately 80% of patients with RA have RF detectable in the serum (termed “seropositive”). The remaining 20% of RA patients never
Rheumatoid Arthritis Patient Presenting for a Total Knee Replacement

Rheumatoid Arthritis Patient Presenting for a Total Knee Replacement  

Perin Kothari and Sree Kolli

in Anesthesiology: A Problem-Based Learning Approach

Print Publication Year: 
Oct 2018
Published Online: 
Nov 2018
eISBN: 
9780190850722
DOI: 
10.1093/med/9780190850692.003.0027
Career: 
Doctor, Qualified, early specialism training, Qualified, late specialism training, Qualified, specialist
Specialty: 
Anaesthetics
Item type: 
chapter
ISBN: 
9780190850692
joints that are involved may have stiffness and may have tenderness and warmth to the touch. What is the primary treatment of RA , and what are your concerns with these medications? Once the diagnosis of RA is made clinically and with laboratory studies, patients are started on medications that can aid in preserving function in those affected joints. These medications are known as disease-modifying antirheumatic drugs. RA patients often are taking pain medications ranging from nonsteroidal anti-inflammatories to chronic opioid therapy for management of their
Genetics and Genomics of Chronic Inflammatory Disorders, II: Rheumatoid Arthritis and Related Arthropathies

Genetics and Genomics of Chronic Inflammatory Disorders, II: Rheumatoid Arthritis and Related Arthropathies  

Kate McAllister and Stephen Eyre

in Genomic Medicine: Principles and Practice (2 ed.)

Print Publication Year: 
Sep 2014
Series: 
Other
Published Online: 
Feb 2015
eISBN: 
9780199398096
DOI: 
10.1093/med/9780199896028.003.0029
Career: 
Doctor, Undergraduate Doctor, Qualified, early specialism training, Researcher
Specialty: 
Clinical Medicine, Clinical Genetics
Item type: 
chapter
ISBN: 
9780199896028
to patients who have clinical synovitis in one joint that is not better explained by any other diagnosis . Once this has been determined, patients who then achieve a point total of 6/10 or higher across four different areas of diagnosis are classified with “definite RA .” The four areas of diagnosis include joint involvement, serological parameters (including anti-CCP and RF), markers of inflammation (including ESR and CRP), and symptom duration. Differentiating early RA from self-limiting or other forms of inflammatory arthritis is challenging. Radiographic changes
Common musculoskeletal conditions

Common musculoskeletal conditions  

Manoj Sivan, Margaret Phillips, Ian Baguley, and Melissa Nott

in Oxford Handbook of Rehabilitation Medicine (3 edn)

Print Publication Year: 
Oct 2019
Series: 
Oxford Medical Handbooks
Published Online: 
Aug 2019
eISBN: 
9780191827389
DOI: 
10.1093/med/9780198785477.003.0035
Career: 
Doctor, Qualified, early specialism training, Qualified, late specialism training, Qualified, specialist
Specialty: 
Allied Health Professions
Item type: 
chapter
ISBN: 
9780198785477
shown to be associated with development of RA . Diagnosis of RA Diagnosis is arrived at through a combination of clinical and laboratory tests. Onset is insidious with inflammation, pain, and stiffness present in synovial joints. The small joints (metacarpophalangeal, proximal interphalangeal, wrist, and metatarsophalangeal joints) are commonly affected with symmetrical changes ( Fig. 35.2 ). Laboratory tests and radiographs are used to support the clinical impression of RA and exclude other differential diagnosis . The American College of Rheumatology and
Musculoskeletal pain in common rheumatological conditions

Musculoskeletal pain in common rheumatological conditions  

Anthony B. Ward, Michael P. Barnes, Sandra C. Stark, and Sarah Ryan

in Oxford Handbook of Clinical Rehabilitation (2 ed.)

Print Publication Year: 
Aug 2010
Series: 
Oxford Medical Handbooks
Published Online: 
Aug 2010
eISBN: 
9780199598946
DOI: 
10.1093/med/9780199550524.003.0026
Career: 
Doctor, Qualified, early specialism training
Specialty: 
Clinical Medicine, Rehabilitation Medicine, Pain Medicine
Item type: 
chapter
ISBN: 
9780199550524
Laboratory tests results in a patient with active RA • Raised inflammatory markers—C-reative protein (CRP) and erythrocyte sedimentation rate (ESR). • Positive immunoglobulin M—rheumatoid factor occurs in 75% of RA patients. It is possible to have RA with a negative rheumatoid factor, where the diagnosis is classified as sero-negative RA . • Acute phase response including raised gamma GT, alkaline phosphatase and ferritin and a reduction in serum albumin and haemoglobin. Radiological changes that can occur with RA • Joint erosions. • Periarticular osteoporosis.
Pathophysiology and causes of pericardial tamponade

Pathophysiology and causes of pericardial tamponade  

John R. Schairer and Steven J. Keteyian

in Oxford Textbook of Critical Care (2 ed.)

Print Publication Year: 
Apr 2016
Series: 
Oxford Textbooks, Oxford Textbooks in Critical Care
Published Online: 
Apr 2016
eISBN: 
9780191810398
DOI: 
10.1093/med/9780199600830.003.0166
Career: 
Doctor, Qualified, specialist, Qualified, late specialism training
Specialty: 
Critical Care
Item type: 
chapter
ISBN: 
9780199600830
demonstrating RV collapse. Increased pericardial pressure also causes RA collapse or inversion ( Fig. 166.2 ) [ 11 ]. The percentage of the cardiac cycle that RA inversion occupies is termed the RA inversion time index. An index ≥0.34 yielded 94% sensitivity, 100% specificity, predictive value of 100%, and accuracy of 97%. The index is believed to be the most sensitive finding for tamponade. The absence of sinus rhythm does not preclude the use of RA collapse to make the diagnosis of tamponade. Increased intrapericardial pressure also explains the loss of the
Case 37

Case 37  

Joel David, Anne Miller, Anushka Soni, and Lyn Williamson

in Oxford Case Histories in Rheumatology

Print Publication Year: 
Oct 2011
Series: 
Oxford Case Histories
Published Online: 
Nov 2012
eISBN: 
9780191753442
DOI: 
10.1093/med/9780199587506.003.0037
Career: 
Doctor, Qualified, early specialism training, Qualified, late specialism training
Specialty: 
Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780199587506
Case 37 A 55-year-old woman with a history of seropositive erosive RA for 7 years attended the ‘flare’ clinic with a 1-day history of an acutely swollen, red, and painful right wrist, associated with increased fatigue and fever. She had been on weekly etanercept 50 mg for the previous year. In clinic 2 weeks previously, her joints were not inflamed and the DAS28 was 3.0. Her medical history included a recent diagnosis of hypertension, for which bendroflumethiazide had been prescribed. In clinic her temperature was 37.5°C. Examination of the right wrist
Rheumatoid arthritis

Rheumatoid arthritis  

Richard Watts, Gavin Clunie, Frances Hall, and Tarnya Marshall (eds)

in Rheumatology (Oxford Desk Reference)

Print Publication Year: 
Apr 2009
Series: 
Oxford Desk References
Published Online: 
Oct 2011
eISBN: 
9780191725746
DOI: 
10.1093/med/9780199229994.003.0006
Career: 
Doctor, Qualified, late specialism training, Qualified, specialist
Specialty: 
Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780199229994
membranous glomerulonephritis (GN) is recognized. More common renal lesions in an RA patient might be GN or tubulointerstitial nephritis from the toxic effects of drugs. Investigations No pathognomonic test result exists for the diagnosis of RA ; therefore, the investigation of polyarthritis is driven by clinical suspicion. Laboratory • FBC shows associated anaemia (either normochromic normocytic or mildly hypochromic microcytic) and thrombocytosis. • Neutropaenia may point to a diagnosis of Felty's syndrome though isolated mild neutropaenia is not an uncommon finding
Connective tissue disease and the lung

Connective tissue disease and the lung  

Stephen Chapman, Grace Robinson, John Stradling, Sophie West, and John Wrightson

in Oxford Handbook of Respiratory Medicine (3 ed.)

Print Publication Year: 
Aug 2014
Series: 
Oxford Medical Handbooks
Published Online: 
Aug 2014
eISBN: 
9780191773112
DOI: 
10.1093/med/9780198703860.003.0022
Career: 
Doctor, Qualified, early specialism training, Undergraduate Doctor
Specialty: 
Clinical Medicine, Respiratory Medicine and Pulmonology
Item type: 
chapter
ISBN: 
9780198703860
Differential diagnosis and standard tests Differential diagnosis and standard tests Rheumatoid arthritis ( RA ) Rheumatoid arthritis ( RA ) Systemic lupus erythematosus (SLE) Systemic lupus erythematosus (SLE) Polymyositis and dermatomyositis Polymyositis and dermatomyositis Systemic sclerosis Systemic sclerosis Sjögren’s syndrome Sjögren’s syndrome Ankylosing spondylitis Ankylosing spondylitis Behçet’s syndrome Behçet’s syndrome Autoantibodies: disease associations Autoantibodies: disease associations Differential diagnosis and standard
Inflammatory joint diseases

Inflammatory joint diseases  

Susan M. Oliver (eds)

in Oxford Handbook of Musculoskeletal Nursing (2 edn)

Print Publication Year: 
Feb 2020
Series: 
Oxford Handbooks in Nursing
Published Online: 
Feb 2020
eISBN: 
9780191869129
DOI: 
10.1093/med/9780198831426.003.0004
Career: 
Nurse, Trainee Nurse, Qualified Nurse
Specialty: 
Medical Skills, Nursing Skills, Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780198831426
Seropositivity of the RA : • Absence of RF does not preclude diagnosis but is a prognostic indicator of aggressive disease with a poorer outcome. Anti-CCP serology has been shown to have a higher specificity and sensitivity than RF. • Social and psychological factors that may reflect poor outcomes ( see ‘ Education Education, social , and Social and psychological aspects of a new diagnosis psychological issues ’ , pp. Education 336 – Social and psychological aspects of a new diagnosis 339 ). Rheumatoid arthritis: assessment RA is a long-term
The adult patient

The adult patient  

Paul Thompson

in Oxford Textbook of Rheumatology (4 ed.)

Print Publication Year: 
Oct 2013
Series: 
Oxford Textbooks
Published Online: 
Oct 2013
eISBN: 
9780191757730
DOI: 
10.1093/med/9780199642489.003.0003
Career: 
Doctor, Qualified, early specialism training, Qualified, late specialism training, Qualified, specialist
Specialty: 
Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780199642489
pattern which may mimic RA in addition to an oligoarthritis or axial disease. Nail dystrophy is usual and psoriatic plaques on the elbows may indicate the diagnosis . For a review of the clinical features see Cantini et al. 22 Nodal ostoarthritis is one of several clinical presentations of osteoarthritis, typically occurring after 40 years of age in women and affecting the DIPs, PIPs, and thumb base although the MCPs are not infrequently affected. Inflammatory forms may mimic RA or psoriatic arthritis. For a recent consensus report on diagnosis see Zhang et al. 23
Musculoskeletal conditions

Musculoskeletal conditions  

Rebecca Jester, Julie Santy, and Jean Rogers

in Oxford Handbook of Orthopaedic and Trauma Nursing

Print Publication Year: 
Apr 2011
Series: 
Oxford Handbooks in Nursing
Published Online: 
Sep 2011
eISBN: 
9780191729850
DOI: 
10.1093/med/9780199569809.003.0056
Career: 
Nurse, Trainee Nurse, Qualified Nurse
Specialty: 
Medical Skills, Nursing Skills, Surgery, Trauma and Orthopaedic Surgery
Item type: 
chapter
ISBN: 
9780199569809
knees or shoulders. The symptoms may be confined to these areas or become more generalized affecting other joints • RA has a rapid or insidious onset • The presence of inflammation in the joints (especially the small joints of the hands and feet) should prompt early referral for diagnosis Common symptoms patients with active RA can experience include: • Joint pain • Joint swelling • Stiffness (often more marked on waking) • Fatigue • Low mood. RA has extra-articular and systemic manifestations including: • Anaemia • Weight loss • Vasculitis • Rheumatoid lung
Rheumatology

Rheumatology  

Kapil Sugand, Miriam Berry, Imran Yusuf, Aisha Janjua, Chris Bird, David Metcalfe, Harveer Dev, and Sri Thrumurthy (eds)

in Oxford Handbook for Medical School

Print Publication Year: 
Apr 2019
Series: 
Oxford Medical Handbooks
Published Online: 
Mar 2019
eISBN: 
9780191761690
DOI: 
10.1093/med/9780199681907.003.0031
Career: 
Doctor, Undergraduate Doctor
Specialty: 
Clinical Medicine, Preclinical Medicine, Medical Skills
Item type: 
chapter
ISBN: 
9780199681907
are there any other signs of SSc or SLE? Does the patient with apparently rheumatoid hands have any nail dystrophy or psoriasis that might alter your differential diagnosis ? Most students are easily able to recognize RA , but often struggle to describe it; if you can produce a smooth, sequential presentation supporting your diagnosis , you will please the examiner. Honours Clinical signs of RA (See Fig. 31.2 .) The most likely case is a rheumatoid hand. Students are very good at identifying a rheumatoid hand (severe cases are obvious) but often struggle
Rapid access and emergency issues

Rapid access and emergency issues  

Susan M. Oliver (eds)

in Oxford Handbook of Musculoskeletal Nursing (2 edn)

Print Publication Year: 
Feb 2020
Series: 
Oxford Handbooks in Nursing
Published Online: 
Feb 2020
eISBN: 
9780191869129
DOI: 
10.1093/med/9780198831426.003.0013
Career: 
Nurse, Trainee Nurse, Qualified Nurse
Specialty: 
Medical Skills, Nursing Skills, Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780198831426
management. There is a differential diagnosis , most commonly crystal arthropathy. Unless a non-infective diagnosis can be made with confidence, an emergency referral to 2° care should be made. If diagnostic doubt remains, treat for septic arthritis until proven otherwise. Box 13.1 Septic arthritis: overview Risk factors for septic arthritis (examples) • Pre-existing joint disease, particularly RA , joint replacement. • Older age, diabetes mellitus, chronic renal failure, or alcoholism. • Immunosuppression (e.g. AIDs, hypogammaglobinaemia). •
Surgical management of rheumatoid arthritis: the upper limb

Surgical management of rheumatoid arthritis: the upper limb  

Ian McNab and Chris Little

in Rheumatoid Arthritis (Oxford Rheumatology Library)

Print Publication Year: 
Feb 2010
Series: 
Oxford Medical Libraries, Oxford Rheumatology Library
Published Online: 
May 2011
eISBN: 
9780191740213
DOI: 
10.1093/med/9780199556755.003.0010
Career: 
Nurse, Qualified Nurse, Doctor, Qualified, early specialism training, Qualified, late specialism training, Qualified, specialist
Specialty: 
Clinical Medicine, Rheumatology
Item type: 
chapter
ISBN: 
9780199556755
affected by rheumatoid synovitis, often with radiographic changes, but because symptoms are similar to those of rotator cuff disease it is important to determine the source of pain. Box Box 10.1 Typical features of ACJ involvement in RA 10.1 shows the typical features of ACJ involvement. Box 10.1 Typical features of ACJ involvement in RA • Pain well localized to the joint • Pain reproduced by high arc (>120 degrees – end of range) elevation movements (abducting the outstretched arm above the patients head) and by horizontal flexion (crossing the arm towards the opposite

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