Rheumatoid arthritis

Question 1

Define rheumatoid arthritis

Answer 1

Chronic inflammatory systemic disease characterised by

symmetrical deforming polyarthritis and extra-articular manifestations

Question 2

Explain the aetiology/risk factors of rheumatoid arthritis

Answer 2

AUTOIMMUNE disease
UNKNOWN cause

Associated with other autoimmune diseases (e.g. Sjogren’s syndrome)

HLA associations:
HLA-DR1
HLA-DR4

Question 3

Summarise the epidemiology of rheumatoid arthritis

Answer 3

COMMON
1% of general population
3 x more common in FEMALES
Peak incidence: 30-50 yrs

Question 4

Recognise the presenting symptoms of rheumatoid arthritis

Answer 4

GRADUAL onset
Joint pain
Swelling
Morning stiffness
Impaired function
Usually affects peripheral joints symmetrically

Systemic Symptoms:
Fever
Fatigue
Weight loss

Question 5

Recognise the signs of rheumatoid arthritis on physical examination

Answer 5

Arthritis-most common in the HANDS

Early Signs
Spindling of fingers
Swelling of MCP and PIP joints
Warm, tender joints
Reduction in range of movement

Late Signs
Symmetrical deforming arthropathy
Ulnar deviation of fingers as a result of subluxation (partial dislocation) of the MCP joint
Radial deviation of the wrist
Swan neck deformity
Boutonniere deformity
Z deformity of the thumb
Trigger finger (inability to straighten the finger, tendon nodule palpable)
Tendon rupture
Wasting of small muscles of the hand
Palmar erythema

Rheumatoid Nodules - firm subcutaneous
nodules (usually found on the elbows, ulnar margin,
palms and over extensor tendons)

Signs of complications

Question 6

Identify appropriate investigations for rheumatoid arthritis

Answer 6

Bloods
FBC - low Hb, high platelets
High ESR and CRP

Rheumatoid factor (found in 70% of RhA patients)
The presence of rheumatoid factor is associated with rheumatoid nodules and extra-articular manifestations

Antinuclear antibodies (30%)

Joint Aspiration - May be performed in the
acute setting to rule out septic arthritis

Joint X-Ray - Deformity, Osteopaenia, Narrowing of joint space, Soft tissue swelling (DONS)