Saturday, March 7, 2009

Rheumatoid arthritis

What is Rheumatoid arthritis (RA)?

It is a systemic chronic inflammatory disease affecting multiple tissue but principally attacking the joints, with a peripheral symmetrical non-suppurative arthritis.

Onset: 30-40 y/o

F:M ratio = 3:1

Need to meet 4/7 criteria.

Pneumonic : RF RISES

R : Rheumatoid Factor ( it is not a diagnostic for RA because it can present in other dz
: Finger/ hand joints involved

: Rheumatoid nodules ( firm, non tender, oval/rounded mass )

: Involvement of 3 or more joint area

: Stiffness in morning => 1 hr

E : Erosions on Xray (xray findings: narrow jt space, erosion of ulnar and radial aspect of PIP jt)

: Symmetrical arthritis

* Rheumatoid Factor = is an IgM (or can be IgG) autoantibodies directed against Fc portion of IgG

* destruction of tendon, ligament and joint capsules produces characteristics deformities including radial deiation of wrist, ulnar deviatian of finger and flexion-hyperextension of abnormalities of fingers (swan-neck deformity, boutonniere deformity)

Typical clinical manifestation in RA :
  • presenting in women of middle age
  • begin insidiously, slow development of sign and symptom
  • joint inflammation ( pain,swelling, morning stiffness)
  • pain gradually relieve on movement
  • involving small joint, mostly proximal interphalangeal jt (PIP) and metacarpophlangeal (MCP), distal interphalangeal (DIP) mostly spared
  • polyarticular
  • symmetrical
  • nonspecific sign and symptom ( fatigue, malaise and depression )
* reference: xpress revision in short case (pg 126), pathophysiologyof disease (pg 687), basic patho, internet



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