What is affected
- Connective tissue disorder targets synovial joints
- Affects hands, feet, C-spine m.c.
- Bilateral symmetric distribution
- Other systems involved: heart, lung, vessels, nervous system, eyes
Clincal Features of Rheumatoid Arthritis
- Onset 20-60 y/o, peak 40-50
- F:M, 3:1 after 40 1:1
- Insidious onset, with articular pain, tenderness, swelling, stiffness
- C-spine is affected up to 80% (late)
- Fatigue, malaise, muscle weakness, fever, tendon rupture, bursitis
- Firm non-tender nodules in 20% of patients: forearm, knees, ankles, hands
- Haygarth’s nodes: soft tissue swelling adjacent to the MCP
- Prognosis unpredictable –remissions and exacerbations –progressive deformity and disability
What leb tests whould you request for a patient with suspected RA?
- ESR/C-RP paralleling disease activity
- 70% of patients will have RF, but it is not specific
What are some pathologic features of RA?
- hands, wrist, feet, knee, hip and spine
- Synovitis, oedema, effusion, periarticular oedema, juxta-articular hyperemia.
- Pannus - vascular granulation tissue spreads over interarticular surface of bone and cartilage.
- “Bare area”: pannus leads to erosions of the bone
- Hyaline cartilage will erode due to chondrolytic enzyme
- Pannus fills the joint, may progress to fibrosis, and rarely, bony ankylosis
General Information JRA:
Potential associated causes
- Seropositive (10%) seronegative (stills disease)
- onset <16yrs
- changes mainly revolve around growth disturbances, joint disfunction, corticosteroid use, inactivity
- ESR elevated, anemias, leukocytosis
Radiographic features of JRA