Rheumatoid arthritis

• • Definition: A systemic inflammatory disease primary affecting the synovial membranes.

  • Epidemiology: F > M

  • Pathology: Type III hypersensitivity reaction. Pannus formation and proliferation in synovium of joint. Granulation tissue > fibrosis and calcification of joint space with resultant ankylosis. Rhemuatoid nodules with central fibrinoid necrosis surrounded by palisading pattern of macrophages, and an outer rim of lymphocytes and plasma cells.

  • Clinical features:

    • Fatigue, malaise, anorexia, vague musculoskeletal complaints.

    • Non-suppurative, proliferative arthritis

    • Extra-articular manifestations sometimes involving skin, heart, blood vessels, and lungs

      • Vasculitis, pulmonary nodules, and secondary amyloidosis

    • Warmth, swelling, tenderness of joints. Bilateral and most commonly in hands.

    • PIP, MCP, wrists, knees, ankles most common joints affected.

    • Subcutaneous painless rheumatic nodules.

    • Instability of cervical spine due to bone erosion.

    • Morning stiffness > 1 hour duration.

    • Boutonniere deformity: Hyperextension of the DIP and flexion of PIP

    • Swan-neck deformity of DIP: Flexion of DIP and extension of PIP

    • Ulnar deviation of the digits

    • Baker's cyst

    • Rheumatoid nodules

    • Felty's syndrome: Rheumatoid arthritis, leukopenia, splenomegaly

  • Associated abs: RF (IgM ab against Fc portion of IgG) in 70 - 80% of patients. It signifies more severe disease. Anemia of chronic disease, elevated ESR

2010 Criteria for the diagnosis of rheumatoid arthritis

A diagnosis of definite RA is based on:

• 1. Presence of synovitis in at least one joint;

  2. Absence of an alternative diagnoses that that explains the presence of synovitis; and

  3. A score >6/10 from individual scores in 4 domains.

• Tx:

  • • NSAIDs for symptomatic relief

    • PT/OT

    • Low-dose steroids

    • DMRARDs

      • Methotrexate

      • Hydroxychloroquine

      • Penicillamine

      • Sulfasalazine