HOD, Rheumatology, Manipal Hospital, Dwarka, New Delhi
Series overview · 8 articles
Diagnosis and Management of Rheumatoid Arthritis
September 1, 2024
Rheumatoid arthritis is a clinical diagnosis, not a laboratory one, and the gap between the two is where most misdiagnosis happens: a positive rheumatoid factor alone means little without the right joint pattern and duration, while a patient with all the right symptoms and a negative test can still have the disease. Dr. Sajal Ajmani, HOD, Rheumatology at Manipal Hospital, Dwarka, New Delhi, used his Jivo Masterclass to walk through how the classification criteria for RA evolved, how the disease is actually diagnosed and monitored in practice, and how treatment is escalated using a structured, evidence-based ladder. This guide introduces a series based on that session.
A session built for a mixed English and French-speaking audience
The session ran with live translation for francophone doctors from the DRC, and the discussion that followed, in both English and French, covered real diagnostic dilemmas: joint involvement patterns, when a positive antibody test is misleading, how to manage a severe acute flare, and what to do when rheumatoid arthritis spreads beyond the joints to the lungs, eyes, heart, kidneys or skin.
What this series covers
This series works through the evolution of RA classification criteria from 1987 to 2010, why rheumatoid factor and anti-CCP antibodies can mislead as often as they help, palindromic rheumatism and preclinical RA, joint involvement patterns, the disease activity scores used to monitor treatment response, the treat-to-target approach and the ladder of conventional, targeted synthetic and biologic DMARDs, how severe flares and steroid pulse therapy are managed, and extra-articular disease affecting organs beyond the joints.
This article is based on a Jivo Masterclass session conducted by Dr. Sajal Ajmani, HOD, Rheumatology, Manipal Hospital, Dwarka, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a rheumatology consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Sajal Ajmani taught doctors across Africa on September 1, 2024.
FROM THE LIVE Q&A
Gadisa Dejene
What is the definition of sustained remission?
Dr. Sajal Ajmani
Sustained remission is defined as at least 12 months of remission before any therapy is decreased.
Frequently Asked Questions
Why does rheumatoid arthritis show a preferential pattern of joint involvement, and why are certain interphalangeal joints spared?▼
DIP (distal interphalangeal) joint involvement is less common in rheumatoid arthritis because there is less synovium in the DIP joints compared to the more commonly affected proximal interphalangeal and metacarpophalangeal joints.
What is the place of pulse or bolus intravenous corticosteroids (solumedrol) in an acute crisis of rheumatoid arthritis, generalised disabling joint pain with high fever?▼
Steroid pulse therapy can be given in severe RA in patients with many swollen and tender joints, usually methylprednisolone 500mg to 1000mg intravenously once a day for one to three days.
Beyond the joints, what organs can rheumatoid arthritis affect, particularly the heart, and how is that treated?▼
Extra-articular involvement is rare, but the lungs can develop interstitial lung disease, the eyes can develop scleritis and dryness, the heart very rarely can develop pericarditis and pericardial effusion, the kidneys very rarely can be affected by glomerulonephritis or amyloidosis, and the skin can develop vasculitis. For cardiac involvement specifically, treatment is steroids combined with methotrexate.
What is the recommended medical treatment for palindromic rheumatism?▼
Hydroxychloroquine.
What is the definition of sustained remission?▼
Sustained remission is defined as at least 12 months of remission before any therapy is decreased.
What does this masterclass series cover?▼
The evolution of RA diagnostic criteria, why serology alone can mislead, palindromic rheumatism, joint involvement patterns, disease activity monitoring, the treat-to-target DMARD ladder, managing severe flares, and extra-articular disease.
Who is Dr. Sajal Ajmani?▼
HOD, Rheumatology at Manipal Hospital, Dwarka, New Delhi, treating rheumatoid arthritis, lupus, psoriatic and juvenile arthritis.
In This Series: Diagnosis and Management of Rheumatoid Arthritis
- 1.Diagnosis and Management of Rheumatoid Arthritis
- 2.Diagnosing Rheumatoid Arthritis: From the 1987 to the 2010 ACR/EULAR Criteria
- 3.Why Rheumatoid Factor and Anti-CCP Alone Don't Diagnose Rheumatoid Arthritis
- 4.Palindromic Rheumatism and Preclinical RA: Recognising Early and Atypical Presentations
- 5.Monitoring Disease Activity: DAS28, SDAI, CDAI and the ACR Response Criteria
- 6.Treat-to-Target: The EULAR 2016 Recommendations and the DMARD Ladder
- 7.Managing Severe Flares: Steroid Pulse Therapy and Achieving Sustained Remission
- 8.Extra-Articular Rheumatoid Arthritis: Lung, Eye, Heart, Kidney and Skin Involvement