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 and radiological remission of disease and to reduce functional limitations and permanent joint damage.

Introduction

  • Rheumatoid arthritis (RA) is a chronic inflammatory arthritis of unknown etiology
    • Most common autoimmune inflammatory arthritis in adults
    • Persistent synovitis leads to joint destruction and deformity

Signs and Symptoms

General 

  • Joint pain and/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 and lower extremity joints are also affected (eg shoulders, elbows, knees and ankles)
  • Syndrome of polymyalgia rheumatica may occasionally be present

Early Rheumatoid Arthritis

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

Established Rheumatoid Arthritis

  • Duration of occurrence of rheumatoid arthritis signs and symptoms is ≥6 months and 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 months

Monoarthritis

  • May indicate onset of a polyarticular disease
    • Interval between monoarthritis and 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 and over Achilles tendons
  • Splenomegaly, renal disease

Etiology

  • Smoking increases incidence for developing rheumatoid arthritis in anti-citrullinated protein antibody (ACPA)-positive patients
  • Oral contraceptives decrease rheumatoid arthritis incidence due to high estrogen content
  • Bacteria (eg Escherichia coli, Helicobacter pylori, Mycobacteria, Mycoplasma, Streptococcus), viruses (eg Epstein-Barr virus, rubella, parvovirus) and periodontal disease may also trigger occurrence of rheumatoid arthritis
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