Rheumatoid Arthritis

Question 1

Definition

Answer 1

Chronic inflammatory systemic disease characterised by symmetrical deforming
polyarthritis and extra-articular manifestations

Question 2

Aetiology

Answer 2

• AUTOIMMUNE disease
• UNKNOWN cause
• Associated with other autoimmune diseases (e.g. Sjogren’s syndrome)

• HLA associations:
o HLA-DR1
o HLA-DR4

Question 3

Epidemiology

Answer 3

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

Question 4

Presenting symptoms

Answer 4

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

• Systemic Symptoms:
o Fever
o Fatigue
o Weight loss

Question 5

Signs on physical examination (early signs)

Answer 5

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

Question 6

Signs on physical examination (late signs)

Answer 6

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

Question 7

Signs on physical examination (other)

Answer 7

• Arthritis - most common in the HANDS
• Rheumatoid Nodules - firm subcutaneous nodules (usually found on the elbows, ulnar margin, palms and over extensor tendons)
• Signs of complications

Question 8

Investigations (bloods)

Answer 8

o FBC - low Hb, high platelets

o High ESR and CRP

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

o Antinuclear antibodies (30%)

Question 9

Investigations

Answer 9

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

• Joint X-Ray
o Deformity
o Osteopaenia
o Narrowing of joint space
o Soft tissue swelling