rheumatoid%20arthritis
RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a systemic autoimmune rheumatic disorder of unknown etiology.
It is the most common form of inflammatory arthritis.
Patient usually complains of joint pain and/or swelling with morning stiffness that lasts for more than an hour.

Goals of treatment are clinical & radiological remission of disease and to reduce functional limitations & permanent joint damage.

Introduction

  • A chronic inflammatory arthritis of unknown etiology
    • Most common autoimmune inflammatory arthritis in adults
    • Persistent synovitis leads to joint destruction & deformity

Signs and Symptoms

General
  • Joint pain &/or swelling
  • Morning stiffness lasting >1 hour
  • Myalgia, fatigue, weight loss, low-grade fever, depression
  • Typically involves the joints of the fingers, wrists, toes
    • Upper & lower extremity joints are also affected (eg shoulders, elbows, knees & ankles)
  • Syndrome of polymyalgia rheumatica may occasionally be present

Early Rheumatoid Arthritis

  • Duration of occurrence of rheumatoid arthritis signs & symptoms is <6 months

Established Rheumatoid Arthritis

  • Duration of occurrence of rheumatoid arthritis signs & symptoms is ≥6 months & meets the classification criteria of rheumatoid arthritis

Palindromic Rheumatism

  • Follows an episodic pattern
    • Joints may be affected for hours to days followed by symptom-free periods lasting for days to month

Monoarthritis

  • May indicate onset of a polyarticular disease
    • Interval between monoarthritis & polyarthritis may extend from days to weeks in patients with progressive disease
  • Large joints are frequently affected (eg shoulder, wrist, hip, knee, ankles)
  • History of joint trauma may be the initiating event

Extra-articular Involvement

  • Anemia, fatigue, pleuropericarditis, neuropathy, scleritis, Sjogren’s syndrome, vasculitis
  • Subcutaneous rheumatoid nodules on extensor surfaces of elbows & over Achilles tendons
  • Splenomegaly, renal disease

Etiology

  • Smoking increases incidence for developing RA in ACPA-positive patients
  • Oral contraceptives decrease RA incidence due to high estrogen content
  • Bacteria (eg Escherichia coli, Helicobacter pylori, Mycobacteria, Mycoplasma, Streptococcus), viruses (eg Epstein-Barr virus, rubella, parvovirus) & periodontal disease may also trigger occurrence of RA
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Rheumatology digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
4 days ago
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
03 Dec 2018
Compelling evidence indicates weight bias, in which obese students appear to do less well in tertiary education than their healthy weight peers, according to a systematic review. University/college attainment appears to be less impacted by socioeconomic factors than school-based achievement.
6 days ago
Relapse following effective treatment of the first episode of schizophrenia may reduce or delay antipsychotic treatment response, a recent study has shown.
Pearl Toh, 2 days ago
Apixaban slashes the risk of recurrent venous thromboembolism (VTE) by 90 percent in cancer patients compared with the low-molecular-weight heparin (LMWH) dalteparin, with no increase in major bleeding risk, according to the ADAM VTE study presented at ASH 2018.