Rheumatoid Arthritis

Question 1

What are some of the key features of inflammation?

Answer 1

Increased perfusion of microvasculature
Movement of fluid and while blood cells into extra-vascular tissues
Pro-inflammatory cytokines

Question 2

What are the four cardinal signs of inflammation?

Answer 2

Rubour (Red)
Calor (Hot)
Tumour (Swelling)
Dolor (Pain)

Question 3

What is the structure of a normal synovial joint?

Answer 3

Two articulating bone surfaces covered with hyaline cartilage
Fibrous capsule lined with synovium
Joint space filled with synovial fluid
Inflammatior of these structures = arthritis

Question 4

What is rheumatoid arthritis?

Answer 4

A disease of the synovial joints.

Question 5

What occurs in the synovial joints in RA?

What occurs in the bone?

Answer 5

Inflammation - chronic inflammatory reaction, infiltration of lymphocytes, macrophages and plasma cells.

Proliferation - tumour like mass ‘pannus’ which grows over the articular cartilage

Cartilage loss due to inflammation.

Question 6

What occurs in the bone in RA?

Answer 6

Focal erosion and periarticular osteoporosis

Generalised osteoporosis in skeleton

Question 7

Seen on x-ray?

Answer 7

Periarticular osteoporosis

Joint space narrowing

Question 8

What is the epidemiology?

Answer 8

1% population

2-3 x more common in women

Question 9

Signs and symptoms?

Answer 9

Symmetrical, deforming, polyarthropathy
(80% hands and feet, some knees)
Significant early morning stiffness >1hr
Improvement with activity
Loss of function
General-fatigue, malaise
Extra-articular involvement

Question 10

What extra-articular involvement may occur and in what percentage of people does this occur?

Answer 10

15-25%

Lungs, heart, GI tract, skin, eyes, kidneys.