Diagnosis and Management of Rheumatoid Arthritis
September 1, 2024
Dr. Sajal Ajmani, HOD, Rheumatology at Manipal Hospital, Dwarka, New Delhi, walks through how the classification criteria for rheumatoid arthritis evolved from 1987 to 2010, why serology alone can mislead, and how disease activity is monitored and treated using a structured, treat-to-target DMARD ladder. The session also covers palindromic rheumatism, managing severe flares with steroid pulse therapy, and extra-articular disease affecting the lungs, eyes, heart, kidneys and skin.
Questions Doctors Asked Dr. Sajal Ajmani
Real questions from the live masterclass, answered by Dr. Sajal Ajmani, Consultant - Rheumatology.
What is the definition of sustained remission?
Asked by Gadisa Dejene
Sustained remission is defined as at least 12 months of remission before any therapy is decreased.
Answered by Dr. Sajal Ajmani
Why does rheumatoid arthritis show a preferential pattern of joint involvement, and why are certain interphalangeal joints spared?
Asked by Dr. Bafomba
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.
Answered by Dr. Sajal Ajmani
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?
Asked by Dr. Bafomba
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.
Answered by Dr. Sajal Ajmani
Beyond the joints, what organs can rheumatoid arthritis affect, particularly the heart, and how is that treated?
Asked by Moderator
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.
Answered by Dr. Sajal Ajmani
What is the recommended medical treatment for palindromic rheumatism?
Asked by Moderator
Hydroxychloroquine.
Answered by Dr. Sajal Ajmani
Read the Full Article Series
- 1.Diagnosis and Management of Rheumatoid Arthritis: A Complete Guide by Dr. Sajal Ajmani
- 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