Thread by @PanktiMehta24

💭When we think of #Rheumatoid #Arthritis , a mental image of this comes up 👇

But does it have to get to this🤔???

🙅NO! Definitely, NO! 🙅

#MedTwitter #MedEd #RheumTwitter #Rheumatology

@MedTweetorials

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🪜The first step is early diagnosis, do not wait until the deformities to form!

💬Think of RA when a patient presents with

🔸Peripheral
🔸Symmetric
🔸Arthritis
🔸Morning stiffness>30 minutes

#MedTwitter

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🧪👨‍🔬A positive Rheumatoid factor is seen in ~70% of cases and anti-CCP in ~75% cases, so about 1/5th of the cases may be seronegative!!

So a good history and clinical examination is the king 👑

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In cases of seronegative RA, don't miss these!

🔸 #Psoriatic #arthritis
🔸 Crystal arthropathies
🔸 Polymyalgia rheumatica
🔸 Generalized #osteoarthritis
🔸 Hansen's disease
🔸#Lupus, sjogren's and other CTDs

#MedTwitter

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Now the drug of choice for RA is the good old methotrexate 💊
But before that a few more things need to be checked ☑️

🔸CBC
🔸LFT
🔸RFT
🔸Chest radiograph
🔸HbsAg & anti- HCV
🔸Screen for other comorbidities, hypothyroidism, osteoporosis when appropriate

#MedTwitter

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If all okay✅, then start with

😧😧Symptom control- NSAIDs, +/- steroids

💊DMARDs- Methotrexate. Start with 10-15mg weekly

⏫Step it up 4-6 weekly to a maximum of 25mg.

🚫🚫You don't want to start a cocktail 🍸 of inappropriately dosed DMARDs🚫🚫

#MedTwitter

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A good way to add on therapy 👇 by using the treat to target🎯 approach (EULAR 2019 recommendations)

ard.bmj.com/content/79/6/6…

#MedTwitter

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And hopefully in a few years, we'll have patients with Rheumatoid #Arthritis on treatment coming like this👇😀

Again, all cases may not be straightforward! A tweetorial on #rheumatoidarthritis in special situations is coming up soon!

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