Rheumatoid Arthritis

Chronic, immune system mediated inflammation affecting the synovial tissue of diarthrodial joints leading to swelling, heat, pain, erythema, limited ROM, reducted functional capacity and often marginal bone erosions generally affecting multiple joints symmetrically and simultaneously, especially hands, feet, knees

History

• When did symptoms begin
• When was diagnosis first made
• Which are worse joints?
• Swelling? Which joints?
• Worse at night or arising in the morning?
• Improved with activity?
• How many minutes of activity does it take in the morning to relieve the worst of the joint stiffness and pain?
• Does pain interfere with sleep, ADLs, recreational activities?
• Prior rheum eval?
• Xrays with evidence of RA?
• h/o of DMARDS
• h/o of corticosteroids
• h/o of orthopedic surgeries
• h/o of RA complications? Ie.  Sjogrens, vasculitis? C1-c3 instability? Myelopathy?

Exam:

• all axial and peripheral joints for TTP, ROM, deformities, nodules
• check for spinal rigidity, skin rashes, SLE, tophi