Rheumatoid Arthritis

Rheumatoid Arthritis

- The hallmark feature of rheumatoid arthritis is persistent symmetric polyarthritis (synovitis) of hands and feet.
- The spontaneous onset of excruciating pain, edema, and inflammation in the metatarsalphalangeal joint of the great toe (podagra) is highly suggestive of acute crystal-induced arthritis.
- Podagra is the initial joint manifestation in 50% of gout cases and is eventually involved in 90%.

- RA is a chronic autoimmune multisystem disease having inflammatory arthritis and systemic manifestation.
 
Pathogenesis –
1.    Women (30 to 50 years) are more commonly affected
2.    HLA-DR 4 Q is a risk factor for RA.
3.    Initial site of disease is synovial membrane
Initiation phase – It is due to non – specific inflammation
 
Amplification phase – Due to T cell activation
 
Chronic inflammatory phase – Due to cytokines IL – 1, TNF- alpha (AIPG 2009) and IL – 6
 
Diagnostic criteria
Four of seven criteria are required
1.    Morning stiffness – lasting 1 hour before maximal improvement
2.    Arthritis of 3 or more joint areas – 14 possible joint areas are right or left PIP MCP, wrist, elbow, knee, ankle and MTP joints
3.    Arthritis of hand joints.
4.    Symmetrical arthritis.
5.    Rheumatoid nodules.
6.    Positive Serum rheumatoid factor
7.    Radiographic changes – including erosions or unequivocal bong decalcification localized in or most marked adjacent to the involved joint.

Related Questions FOOT & ANKLE

- The hallmark feature of rheumatoid arthritis is persistent symmetric polyarthritis (synovitis) of hands and feet.
- The spontaneous onset of excruciating pain, edema, and inflammation in the metatarsalphalangeal joint of the great toe (podagra) is highly suggestive of acute crystal-induced arthritis.
- Podagra is the initial joint manifestation in 50% of gout cases and is eventually involved in 90%.

- RA is a chronic autoimmune multisystem disease having inflammatory arthritis and systemic manifestation.
 
Pathogenesis –
1.    Women (30 to 50 years) are more commonly affected
2.    HLA-DR 4 Q is a risk factor for RA.
3.    Initial site of disease is synovial membrane
Initiation phase – It is due to non – specific inflammation
 
Amplification phase – Due to T cell activation
 
Chronic inflammatory phase – Due to cytokines IL – 1, TNF- alpha (AIPG 2009) and IL – 6
 
Diagnostic criteria
Four of seven criteria are required
1.    Morning stiffness – lasting 1 hour before maximal improvement
2.    Arthritis of 3 or more joint areas – 14 possible joint areas are right or left PIP MCP, wrist, elbow, knee, ankle and MTP joints
3.    Arthritis of hand joints.
4.    Symmetrical arthritis.
5.    Rheumatoid nodules.
6.    Positive Serum rheumatoid factor
7.    Radiographic changes – including erosions or unequivocal bong decalcification localized in or most marked adjacent to the involved joint.