4 . Knows how to diagnose and treat a patient with rheumatoid arthritis[]
Diagnosis []
The diagnosis of rheumatoid arthritis is principally clinical, as there is no single sensitive and specific test. The clinician will use resouces such as:
- Patient history
- Clinical examination
- Basic bloods - anaemia of chronic disease & acute phase responses (ESR, CRP, high platelets)
- Rheumatoid factor
- Anti-CCP
- Radiology
- Synovial fluid analysis (atypical presentations only)
Treatment[]
- MDT approach (involve specialist nurses, physiotherapists, psychologists)
Medical managment:
- DMARDs - Initial therapy, tapered down to minimum effective dose over time
- glucocorticoids - for short term therapy (flare control). Occasionally used in long term therapy after all other options have been exhausted.
- biologic agents - used where response to DMARDs is inadequate
- analgesia - NSAIDs and COX-2 selective inhibitors
Surgical management: used where optimum medical management has failed, and there is persistent or worsening joint pain, joint deformity, persistent localised synovitis. Examples of surgical procedures used in RA include:
- associated carpal tunnel release
- joint replacement
- treatment of cervical myelopathy
- Stress fracture treatment
- Managment of imminent/actual tendon rupture