Non-Specific Inflammatory Arthritis & Rheumatoid Arthritis

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Clinical Features SIGNS AND SYMPTOMS

  • Pain and swelling in joint
  • Fever (especially in children)
  • For rheumatoid arthritis key symptoms are: Chronic pain, joint swelling, and deformity (see RA section below)

INVESTIGATIONS

  • FBC
  • X-ray joint
  • ESR

Treatment                                                                                     

Treatment Adults:

NSAIDS

  • Give Ibuprofen 1.2-1.8g daily in 8 hourly after food

Alternatively:

  • Give Aspirin 300-900 mg after food every 4 hours. Maximum of 4g daily in divided doses in acute conditions
  • Review after 7 days 
  • If not responding change to an alternative NSAID:
    • Give Indomethacin 25 - 50mg 8 hourly after food for another 7 days 
  • or
    • Give Diclofenac Sodium 25-50mg 8 hourly after food or SR 75mg bd for another 7 days

Consider referral for specialist opinion in patients with arthritis not responding to NSAIDs for further investigations and treatment

  • Intra-articular steroid injection with Depo Medrol or Triamcinolone
  • Disease Modifying anti-rheumatic agents (see RA section below)

Children:

  • Always refer to hospital
  • Prior to referral, give Aspirin 20 mg/kg after food 6 hourly or Paracetamol 15mg/kg 8 hourly