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
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