11.2
Non-Specific Inflammatory Arthritis and Rheumatoid Arthritis
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 11, Musculoskeletal Disorders.
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 non-steroidal anti- inflammatory drug (NSAID):
- Give Indomethacin 25 - 50mg 8 hourly afterfood foranother 7days 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
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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