Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of chronic, symmetrical polyarthritis involving small joints of the hands (MCP, PIP) and wrists. Reports morning stiffness lasting >60 minutes, improving with activity. Associated with fatigue, low-grade fever, and constitutional symptoms. Serology confirms positive Rheumatoid Factor (RF) and/or Anti-CCP antibodies. No history of dactylitis or axial involvement suggestive of spondyloarthropathy.
Clinical Examination Findings
General: Patient appears in mild distress due to joint pain. Musculoskeletal: Symmetrical swelling, tenderness, and warmth noted in MCP, PIP, and wrist joints bilaterally. Reduced range of motion in affected joints. Ulnar deviation and swan-neck deformities absent/present. No evidence of skin rash, psoriatic plaques, or nail pitting. Lymphadenopathy absent.
Treatment Protocol
Initiate DMARD therapy (Methotrexate 15-25mg weekly). Prescribe Folic acid supplementation. Short-term bridging therapy with low-dose oral corticosteroids (Prednisolone 5-10mg daily) for symptom control. Monitor CBC, LFTs, and Creatinine every 3 months. Consider biologic DMARDs if inadequate response to conventional synthetic DMARDs.