Pre PACES Podcast #58 Rheumatoid arthritis (part 1)
11 snips
Apr 9, 2023 
Dr Arrianne Laws, consultant rheumatologist and Medical Take co‑host, explores rheumatoid arthritis in clinical exam settings. She discusses typical presentations and history clues. She walks through hand exam essentials and recognisable deformities. She highlights multisystem checks and common differentials.
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Elicit Functional And Work Impact Early
- Always ask about functional and work impact early because patients worry most about tasks requiring fine motor skills.
- Elicit specific examples like difficulty fastening a bra, holding a kettle, typing, or losing work due to symptoms.
Extra Articular Clues Reveal Mimics And Alternatives
- Extra-articular clues help separate seronegative causes and mimicries: ask about psoriasis, bowel symptoms, eye pain, breathlessness, and unusual lumps.
- Psoriasis may be subtle (scalp/ear rash) and patients often don't recognise it, so examine carefully.
Use Joint Distribution To Narrow Differential
- Use joint distribution to narrow differentials: rheumatoid classically causes symmetrical MCP and PIP small-joint polyarthritis.
- Psoriatic arthritis often hits DIP joints, can be asymmetrical or monoarthritis, and may show dactylitis or nail changes.