Rheumatoid Arthritis

Question 1

Define rheumatoid arthritis

Answer 1

Chronic systemic inflammatory disease characterised by symmetrical deforming polyarthritis

Question 2

What are the causes/risk factors of rheumatoid arthritis?

Answer 2

Autoimmune disease with unknown aetiology
Rheumatoid factor positive (IgM antibody against
IgG)
Hereditary predisposition + environmental trigger -
> autoimmune reaction -> release of inflammatory
mediators and cytokines -> chronic inflammation of
the synovium -> proliferation of synovium ->
pannus formation -> pannus invades and erodes
cartilage and bone surface -> joint destruction

Associated with:
• Raynaud’s phenomenon
• Sjögren’s syndrome
• HLA-DR1, DR4
• lower zone lung fibrosis

Risk Factors
• Female
• Family history
• Smoking

Question 3

What are the symptoms of rheumatoid arthritis?

Answer 3

Symmetrical polyarthropathy affecting the small joints of the hands (MCPs, PIPs), wrists, knees, ankles, MTPs
• Joint pain/swelling/erythema
• Early morning stiffness >1 hour
• Reduced ROM/loss of function
• Symptoms relieved by exercise (worse at rest)

Systemic symptoms
• Fever
• Weight loss
• Malaise

Question 4

What are the signs of rheumatoid arthritis?

Answer 4

• Z-deformity of thumb
• Swan neck deformity
• Boutonniere’s deformity
• Ulnar deviation at MCPs (joint instability and subluxation)
• Radial deviation of wrist
• trigger finger
• wasting of small muscles of hands
• rheumatoid nodules

Question 5

What investigations are carried out for rheumatoid arthritis?

Answer 5

• Bloods
- FBC - low Hb, raised platelets
- Raised ESR and CRP
- Rheumatoid factor (70%)
- Anti-CCP
- ANA (30%)
• X-ray
- Soft tissue swelling
- Angular deformity
- Periarticular erosions
- Osteoporosis