RHEUMATOID

ARTHRITIS

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Contents
 Introduction/Epidemiology
 Pathophysiology
 Pathology
 Clinical features
 Diagnosis
 Management
 Complications
 Prognosis
Introduction
 Autoimmune disorder characterized by
chronic inflammatory joint disease with a
multisystem involvement
 Prevalence 1-3% of adult
 Women:men= 3:1
 Peak at 40s & 50s
 Common in smokers & urban population
Pathophysiology

Genetic susceptibility

Immunological process

Inflammatory reaction
Stage
Ero
Pathology
Sta ge1-2 Synovitis
– Destruction
vascular congestion,
sion of articular
infiltration of inflammatory
ca rtilathickening
cells, ge, bo ne of& caps ule,
tendo
form n, synovial effu sion
pannus

Sta
ge
3–
Def
or
mit
y
Du
e
to
arti
cul
ar
de
str
ucti
on,
ca
ps
ula
r
str
etc
hin
g
an
d
ten
do
n
rup
tur
e
 Clinical Features
 Symmetrical
polyathritis/polysynovitis
 Early stages
pain, swelling, loss of mobility esp. PIP
& MCP
generalized morning stiffness
muscle pain, constitutional sx;
tiredness, LOW, loss of appetite, fever
sx spread to other joints – wrists, feet,
knees, shoulder
 Later stages
Joint deformities
Restricted joint movements
Rheumatoid deformities:
Hands/wrists – Boutonniere,
swan-neck
Feet/ankles – valgus feet, clawed
toes
 Extra-articular features
Skin – rheumatoid nodules, skin
atrophy/ulceration, vasculitis
Lungs – pulmonary fibrosis, pleural effusion
Heart – pericarditis, endocarditis
Kidneys – renal amyloidosis
Eyes – episcleritis, scleromalacia
Neurological – peripheral neuropathy, carpal
tunnel syndrome
Diagnosis
 Presence of bilateral symmetrical
polyarthritis of proximal joints of hands
or feet for at least 6 weeks
 Imaging – x-ray; early - soft tissue
swelling, periarticular osteoporosis, later
- marginal bony erosion, narrowing of
articular space
 Blood tests – rheumatoid factor, FBC,
ESR
 Criterias for the diagnosis of RA
( American Rheumatism Association 1987)
- Morning stiffness (>1 hour)
- Arthritis of 3 or more joint areas At least 6
weeks
- Arthritis of hand joints
- Symmetrical arthritis
- Rheumatoid nodules
- Rheumatoid factor
- Radiological changes of RA

 Diagnosis of RA is made with 4 or > criterias

Management
 Stop the synovitis
1st line - NSAIDS – control of pain, stiffness, swelling eg.
aspirin, indomethacin
2nd line drugs – DMARD eg. methotrexate, gold,
penicillamine
Other – systemic glucocosticoid
 Keep the joints moving
 Prevent deformity
 Reconstruct
synovectomy, arthrodesis, osteotomy, arthroplasty
 Rehabilitate
Physiotherapy, occupational therapy
Complications
 Fixed deformities
 Muscle weakness
 Joint rupture
 Infection
 Spinal cord compression
 Systemic vasculitis
 Amyloidosis
Prognosis
 Poof prognostic factors:
Involve > 20 joints
High level of rheumatoid factor or elevated ESR
Periarticular erosion
Rheumatoid nodules
Severe muscle wasting
Joint contracture
Vasculitis
Earlier age of onset
References
 Apley’s Systems of Orthopaedics and
Fractures, 8th Edition
 http://en.wikipedia.org/wiki/Rheumatoid_
arthritis
 http://www.emedicinehealth.com/rheuma
toid_arthritis/article_em.htm#Rheumatoi
d Arthritis Overview