Rheumatoid arthritis
Definition
Rheumatoid arthritis (RA)- a chronic, inflammatory autoimmune disorder
It involves the immune system
Affects the joints.
A disabling and painful inflammatory condition
Leads to substantial loss of mobility due to pain and joint destruction
It is a systemic disease, often affecting extra-articular tissues throughout the body
including the skin, blood vessels, heart, lungs, and muscles.
Incidence
Affects women three times more often than men
At any age.
Commonly between 40 and 50
Signs and symptoms
Synovitis
Polyarticular
Symmetrical involvement
Most commonly, the small joints in the hands and feet
Larger joints (shoulders, knees etc) can also be affected
The small joints of the cervical spine can also be involved.
Morning stiffness
a soft, "doughy" swelling
pain, tenderness to palpation and movement, local warmth, and functional impairment.
spontaneous remission may occur in a very small number of patients,
persistent symptoms, waxing and waning in intensity
Deformities
progressive deterioration of joint structures leading to deformities and disability.
The fingers show ulnar deviation and assume unnatural shapes.
Classical deformities in rheumatoid arthritis are the Boutonniere deformity (Hyperflexion at the proximal interphalangeal joint with hyperextension at the distal interphalangeal joint),
swan neck deformity (Hyperextension at the proximal interphalangeal joint, hyperflexion at the distal interphalangeal joint).
Z-Thumb deformity = with fixed flexion and subluxation at the metacarpophalangeal joint, and hyperextension at the IP joint.
Osteoporosis around inflamed joints.
Extra-articular manifestations
Constitutional symptoms such as fever, malaise, loss of appetite and loss weight due to cytokines released in to the blood stream due to an abnormal immune reaction.
Vasculitis affecting many other organ systems often gives rise to systemic complications.
general tiredness
lassitude,
elevated erythrocyte sedimentation rate (ESR)
anemia + hepatosplenomegaly + leukopenia - referred to as Felty's syndrome),
Lymphocytic infiltration of the salivary and lacrimal glands (Sjögren's syndrome),
pericarditis
pleurisy
alveolitis
scleritis
Cutaneous manifestations
Rheumatoid nodule over bony prominences, such as the olecranon, the calcaneal tuberosity, the Metacarpophalangeal joints
Several forms of vasculitis
Microinfarcts around the nailfolds.
Recurrent vascular thrombosis
Second trimester miscarriages.
Pyoderma gangrenosum, a necrotizing, ulcerative, noninfectious neutrophilic dermatosis.
Sweet's syndrome, a neutrophilic dermatosis
Viral infections
Drug reactions
Erythema nodosum
Lobular panniculitis
Atrophy of digital skin
Palmar erythema
Diffuse thinning (rice paper skin), and skin fragility.
Pulmonary
Fibrosis may occur spontaneously or as a consequence of therapy (for example methotrexate).
Caplan's syndrome = lung nodules in patients with rheumatoid arthritis
Pleural effusions .
Renal
Amyloidosis
Cardiovascular
Pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis myocardial infarction congestive heart failure
Ocular
Keratoconjunctivitis sicca, scleritis, episcleritis and scleromalacia.
Neurological
Peripheral neuropathy
Carpal tunnel syndrome
Atlanto-axial subluxation compressing the spinal cord. At first the patient experiences clumsiness but without due care this can progress to quadriplegia.
Lymphoma
The incidence of lymphoma is increased in RA
Treatment
Rest, exercise, adequate nutrition, physical measures, drugs :
Prednisolone, Hydroxychloroquine, Naproxen, Diclofenac, Ibuprofen, Indomethacin, Ketoprofen, Pyroxicam, Meloxicam, etoricoxib, Sulphasalazine, Methotrexate, Etanercept, Leflunomide
