Rheumatoid Arthritis

Question 1

What is the pathology of Rheumatoid Arthritis?

Answer 1

Systemic autoimmune disease
inflammatory arthritis with extra-articular involvement
Synovium infiltrated by immune cells
Fibroblasts and inflammatory cells lead to osteoclasts generation
Bone erosion and loss of joint integrity
Systemic inflamation and autoimmunity previous to joint inflamation

Question 2

What are the risk factors?

Answer 2

\+female 2-3:1
\+age
\+Northern America and Northern Europe 
Genetic factors
Smoking 
Air pollution
Obesity
Low vitamin D

Question 3

What is the clinical presentation of Rheumatoid Arthritis?

Answer 3

Poly arthritis of small hand joints - PIP,MCP,RCJ
Insidious onset over period of months
Commonly elbows, shoulders, hips, knees, ankles, MTP
Morning joint stiffness
Fatigue
Deformity, pain, weakness, restricted movement
If C spine include can lead to C1-2 instability

Question 4

How is Rheumatoid Arthritis managed?

Answer 4

Symptom management
Disease Modifying Anti-Rheumatic Drugs (DMARD)
Nutrition
Physiotherapy