Hello, 

Welcome fellow medics,

I hope you are all well and safe. The time is drawing near for the CSA and so on that note, I am hoping that the revision is going to plan. 

Below is a quick reminder of rheumatoid arthritis. This station can either be in the form of explaining the condition or history taking from a patient with symptoms. It can be easily mimicked by actors or even a real life patient may come in.

Here are 5 quick things to consider when consulting with a patient with suspected rheumatoid arthritis (RA). 

1.Early morning stiffness- how long and when?

RA is an inflammatory condition that is common. The symptoms admittedly over lap with other inflammatory conditions but there are some distinct features that should make us suspect RA. RA tends to present with symmetrical small joint involvement of: pain, swelling of joint (not bone) and importantly early morning stiffness of the joints lasting > 1 hour. 

2. Impact on activities of daily living

For all conditions/symptoms we should explore the impact on ADLs (activities of daily living), but it is even more important in conditions affecting a patients function i.e. musculoskeletal and rheumatological contains. Remember to ask about dressing/washing/cooking/cleaning and working. Explore the patients life and show genuine interest in this area. 

3. Diagnosis process - urgent referral

Fortunately, there are many successful (albeit strong medications) that can now modify the disease outcome for patients with rheumatoid arthritis, as long as the diagnosis is prompt. Therefore, if you suspect RA, refer immediately (whilst awaiting blood test results). This shows that you appreciate the importance of a fast referral. 

4. Bloods

Get baseline bloods done i.e. FBC/CRP/ESR/U+Es/LFTs. A special shout out to LFTs- this is very important as you want to check LFTs before starting a patient on DMARDS, and so requesting this shows you appreciate the importance of working as a team with your colleagues in secondary care (rheumatologist) and also blood test monitoring with DMARDS. In addition, there are specific diagnostic bloodtests (which depends on the NHS trust) - Rheumatoid Factor and Anti CCP. 

5. Management - MDT approach

When explaining the condition to the patient,  make sure that you do not spend all your time talking about the ‘pharmacological management’ but also concentrate on the MDT approach. 

This includes the rheumatologist, occupational therapist, Rheumatology nurse etc. 

I hope you found this information useful.

Best of luck with all your revision, stay focused and think of the end goal.

L x