Question
14 yr old child with Naive Rheumatoid Arthritis patient as shown in image . What should be the correct treatment of given condition:
A. DMARD with short course of Steroids
B. Only NSAID’S
C. DMARD after initial 3 months of NSAID’S
D. Monotherapy with TNF drugs
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Correct Answer » A Explanation |
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Monotherapy with TNF drugs
Answer A. DMARD with Steroids
Given condition is Rheumatoid Arthritis
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Rheumatoid arthritis (RA) is a chronic autoimmune multisystemic inflammatory disease which affects many organs but predominantly attacks the synovial tissues and joints.
Clinical features:
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It occurs between the age of 20 to 50 years.
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Women are affected about 3 times more commonly than men.
Following presentations are common:
a) An acute, symmetrical polyarthritis:
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Pain and stiffness in multiple joints (at least four)
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Symptoms of articular inflammation.
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The joints affected most commonly are the metacarpo- phalangeal joints, particularly that of the index finger.
Other joints affected commonly are (given in Table):
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Common
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• MP joints of hand • PIP joints of fingers • Wrists, knees, elbows, ankles |
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Less common |
• Hip joint • Temporomandibular joint |
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Uncommon |
• Atlantoaxial joint • Facet joints of cervical spine |
On examination:
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Swollen boggy joints as a result of intra-articular effusion, synovial hypertrophy and oedema of the periarticular structures.
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The joints may be deformed.
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Deformities in Rheumatoid arthritis |
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Hand
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• Ulnar drift of the hand • Boutonniere deformity • Swan neck deformity |
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Elbow |
• Flexion deformity |
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Knee |
• Early – flexion deformity Late – triple* subluxation |
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Ankle |
• Equinus deformity |
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Foot |
• Hallux valgus, Hammer toe, etc. |
Treatment and prognosis
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Treatment of RA is aimed at improving the symptoms and slowing disease progression.
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Therapy is with a combination of corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs), and TNF antagonists (e.g. etanercept).
