Diagnostic Criteria of rheumatoid arthritis and DD from rheumatic fever

Criteria of rheumatoid arthritis
1- Morning stiffness lasting > 1 hour.
2- Arthritis of 3 or more joints areas .
3- Arthritis of hand joints and wrists (at least in one area e.g wrist, Mep or PIP joint).
4- Symmetric arthritis i.e. simultaneous invoivement of the same joint areas on both sides .
5- Rheumatoid nodules.
6- Positive rheumatoid factor.
7- Typical radiological changes (Hand and wrist)
   • Erosions, Loss of joint space,
   • Juxta-articular osteoporosis.
   • The above criteria must be present for at least 6 weeks.
   • Our diagnosis is made with 4 or more criteria .

Differential Diagnosis of rheumataid disease

• Connective tissue diseases.
• Seronegative arthropathies.
• Gout, pseudogout and osteoarthritis.
• Viral arthritis.

Differential Diagnosis of rheumatoid arthritis from rheumatic fever

Q : Patient with rheumatoid arthritis then he developed lower limb oedema what is DD ?

1- Nephrotic syndrome ( due to drugs or amyloidosis)
2- Interstitial pulmonary fibrosis --->  cor pulmonale.
3- Myocarditis --->  biventricular failure.

Q :  Patient C/O at arthropathy then developed proteinuria  , what is DD ?

1- Rheumatoid arthritis ~ nephrotic (drugs OR amyloidosis).
2- SLE ~ GN ( nephrotic OR nephritic ).
3- Any arthropathy --->  NSAID --->  minimal lesion GN.
4- FMF
   •  Arthritis        • Serositis         • Amyloidosis kidney ( late ) .
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Tamer Mobarak

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