Rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (RA) is a symmetric, inflammatory polyarthritis and chronic, progressive, autoimmune disorder Autoimmune Disorder Septic Arthritis. Presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor occurs most commonly in middle-aged women with joint swelling Swelling Inflammation, pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, and morning stiffness (often in the hands). Systemic inflammation Systemic Inflammation Surgical Site Infections can lead to extraarticular manifestations such as rheumatoid nodules, interstitial lung disease, Felty syndrome, and pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis. Prolonged and severe disease can lead to irreversible joint deformities. Diagnosis is based on strong clinical suspicion and confirmed by the presence of rheumatoid factor Rheumatoid factor Antibodies found in adult rheumatoid arthritis patients that are directed against gamma-chain immunoglobulins. Autoimmune Hepatitis (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies Antibodies Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution. Immunoglobulins: Types and Functions, and characteristic imaging. Management involves long-term disease-modifying antirheumatic drugs Disease-modifying antirheumatic drugs Disease-modifying antirheumatic drugs are antiinflammatory medications used to manage rheumatoid arthritis. The medications slow, but do not cure, the progression of the disease. The medications are classified as either synthetic or biologic agents and each has unique mechanisms of action and side effects. Disease-Modifying Antirheumatic Drugs (DMARDs) ( DMARDs DMARDs Disease-modifying antirheumatic drugs are antiinflammatory medications used to manage rheumatoid arthritis. The medications slow, but do not cure, the progression of the disease. The medications are classified as either synthetic or biologic agents and each has unique mechanisms of action and side effects. Disease-Modifying Antirheumatic Drugs (DMARDs)), biologic agents Biologic Agents Immunosuppressants, and physical therapy Physical Therapy Becker Muscular Dystrophy. Glucocorticoids Glucocorticoids Glucocorticoids are a class within the corticosteroid family. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily benefit from the antiinflammatory and immunosuppressive effects of this class of drugs. Glucocorticoids and nonsteroidal antiinflammatory drugs Nonsteroidal Antiinflammatory Drugs Nonsteroidal antiinflammatory drugs (NSAIDs) are a class of medications consisting of aspirin, reversible NSAIDs, and selective NSAIDs. NSAIDs are used as antiplatelet, analgesic, antipyretic, and antiinflammatory agents. Nonsteroidal Antiinflammatory Drugs (NSAIDs) ( NSAIDs NSAIDS Primary vs Secondary Headaches) are the treatment of choice for acute exacerbation.
Last updated: 26 Nov, 2021
The cause of rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (RA) is unknown, but several risk factors play a role.
Histopathology of the synovium in RA: Fibrocollagenous tissue with dense, mixed inflammatory infiltrate comprised of lymphocytes Lymphocytes Lymphocytes are heterogeneous WBCs involved in immune response. Lymphocytes develop from the bone marrow, starting from hematopoietic stem cells (HSCs) and progressing to common lymphoid progenitors (CLPs). B and T lymphocytes and natural killer (NK) cells arise from the lineage. Lymphocytes: Histology, plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products cells, neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation, and proliferative blood vessels
Image: “Histopathology” by Department of Orthopaedics, Grant Government Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, India. License: CC BY 4.0Pathological joint changes in RA
Image: “Rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis joint” by US gov. License: Public Domain, cropped by Lecturio.Arthroscopic images in RA: Exuberant synovial growth with villi-like proliferation
Image: “Arthroscopic image of synovial growth” by Department of Orthopaedics, Grant Government Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, India. License: CC BY 4.0Arthroscopic image of synovial proliferation of the knee in a patient with RA
Image: “Arthroscopic image of synovial growth” by Department of Orthopaedics, Grant Government Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, India. License: CC BY 4.0Swan neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess deformity Deformity Examination of the Upper Limbs of the fifth finger in a patient with RA
Image: “Swan-neck deformity Deformity Examination of the Upper Limbs” by Khatam-al-Anbia Eye Research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest Center, Mashhad University of Medical Sciences, Mashhad, Iran. License: CC BY 2.5Synovitis in RA:
Presentation
Presentation
The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck.
Normal and Abnormal Labor includes symmetric
swelling
Swelling
Inflammation and tenderness of MCP joints, PIP joints, and wrists.
Physical exam findings in RA:
An RA patient with several classic deformities: ulnar deviation (left
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy) and Boutonniere
deformity
Deformity
Examination of the Upper Limbs (3rd, 4th, and 5th fingers of the right
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy)
Rheumatoid nodules in RA:
Firm, non-tender, subcutaneous
swelling
Swelling
Inflammation on the extensor surface of the elbow in a RA patient
Rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis (RA) diagnosis is based on high clinical suspicion and confirmed by serology Serology The study of serum, especially of antigen-antibody reactions in vitro. Yellow Fever Virus and imaging.
Radiograph of the hands in a patient with RA:
“Z”
deformity
Deformity
Examination of the Upper Limbs shown in both thumbs and joint-space narrowing/bony
erosion
Erosion
Partial-thickness loss of the epidermis
Generalized and Localized Rashes noted in CMC, MCP, and PIP joints
Ultrasound and MRI findings in RA:
(a) (b): Signs of destruction and
inflammation
Inflammation
Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function.
Inflammation on ultrasonography
(c) (d) (e): Magnetic resonance imaging showing 2nd MCP joint in a patient with established RA.
(thin arrows indicate erosive change; thick arrows indicate synovitis)
The goal is to prevent deformity Deformity Examination of the Upper Limbs and permanent damage. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship should be referred to a rheumatologist.
Nonpharmacological therapies:
Acute exacerbation management:
Long-term pharmacological therapy:
Surgery:
Additional considerations: