Rheumatoid Arthritis

Question 1

what is it

Answer 1

inflammatory autoimmune disorder characterised by joint pain, swelling and synovial destruction

Question 2

aetiology is multifactorial meaning

Answer 2

• genetic predisposition
• environmental triggers
• hormonal factors

Question 3

what triggers it

Answer 3

infection and cigarette smoking

Question 4

what happens initially in the pathophysiology

Answer 4

Initially, non-specific inflammation affects the synovial tissue, which is later amplified by activation of T cells

With time it may lead to inflammatory joint effusion and synovial hypertrophy as awell as progressive distruction and deterioration of cartilage and bone

Inflammatory pannus (inflammatory granulation tissue) forms which produces proteinases that destroy the cartilage extracellular matrix

Tendon rupture and soft tissue damage can occur leading to joint instability and sublaxation

Chronic phase - fibrosis, deformity

Question 5

Clinical presentation - articular manifestations

Answer 5

Polyarthralgia
- symmetrical pain and swelling in affected joints
- rapid onset

early morning stiffness that usually improves with exercise

reduction in grip strength

joint deformities

Question 6

clinical presentation - signs

Answer 6

• swelling of affected joints
• positive compression tests of MCP and MTP joints
  -bouchard’s nodes
  -synovial herniation

Question 7

investigations bloods

Answer 7

-raised inflammatory markers (CRP, plasma blood viscosity)
-autoantibodies (presence of rheumatoid factor or anti-CCP antibodies

Question 8

investigations imaging

Answer 8

X-ray of hands and feet - helps with diagnosis and determination of disease severity

USS - may be useful in detecting synovial inflammation

MRI - only use if diagnostic doubt

Question 9

management