🧵 Clues Your “Arthritis” Patient Doesn’t Actually Have RA
Not all swollen joints are rheumatoid arthritis.
Some look identical—but aren’t.
Here’s how to spot RA mimics before the label sticks forever 👇
@IhabFathiSulima @DrAkhilX @SarahSchaferMD @Janetbirdope #MedTwitter #Rheumatology
1. It’s asymmetric
RA loves symmetry.
If one side is swollen but the other is fine—think again.
2. The wrong joints are involved
RA = MCP, PIP, wrists.
If DIP joints are involved → think OA, psoriatic arthritis.
If only large joints → think reactive, viral, crystal arthritis.
3. Too acute for RA
RA builds over weeks.
If swelling peaks in 24–48 hrs → think gout, pseudogout, septic arthritis, viral arthritis.
4. Crystal clues
RA won’t give you urate crystals.
If joint aspirate shows crystals → gout or CPPD.
5. Psoriasis changes the game
Skin rash? Nail pitting?
Psoriatic arthritis can look just like RA—until you check the skin.
6. Negative RF & anti-CCP + weird features
If both are negative, especially with atypical joint pattern → think seronegative spondyloarthritis, lupus, viral arthritis.
7. Systemic features out of proportion
High fever, rash, serositis, cytopenias → maybe Still’s disease, lupus, vasculitis.
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