Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symmetric polyarthritis involving small joints of hands (MCP, PIP) and wrists. Reports morning stiffness lasting >60 minutes, improving with physical activity. Denies recent infections, rashes, or ocular symptoms. Systemic symptoms include fatigue and low-grade fever.
Clinical Examination Findings
Musculoskeletal exam reveals bilateral, symmetric swelling, tenderness, and warmth in MCP and PIP joints. Ulnar deviation noted in bilateral hands. Reduced range of motion in wrists. No evidence of dactylitis or axial involvement. Gait is stable.
Treatment Protocol
Initiate DMARD therapy (Methotrexate) with folic acid supplementation. Prescribe short-term NSAIDs or low-dose corticosteroids for symptomatic bridge therapy. Monitor CBC, LFTs, and creatinine. Refer to physical therapy for joint preservation and mobility.