Rheumatoid Arthritis

Question 1

What is it?

Answer 1

> Systemic autoimmune disease where immune system attacks joints
Characterised by
- inflammatory cells infiltrating synovium
- extra-articular involvement

Question 2

Process

Answer 2

> Immune cells infiltrate synovium (fibroblasts and inflam cells cause osteoclast generation)
Leading to bone erosion + loss of joint integrity
(*systemic inflammation and autoimmunity occur long before onset of joint inflammation)

Question 3

Epidemiology

Answer 3

> North Europe and America
Female
Increases with age
* In paediatric population it is referred to as juvenile idiopathic arthritis

Question 4

Risk Factors

Answer 4

> Genetics
> Smoking
> Air pollution
> Obesity
> Low vitamin D

Question 5

Clinical Presentation

Answer 5

> Polyarthritis of small joints of hand = v common
Insidious onset (months)
Joint stiffness in morning
Fatigue
Deformity, Pain, Weakness, Restricted motion in affected joints (shoulder, elbow, hip, knee, ankle also commonly affected)

Question 6

Management

Answer 6

Mostly about managing symptoms
> Drugs (Disease modifying anti-rheumatic drugs = DMARDS)
> Nutrition
> Physio
- education (manage condition + flare ups)
- exercise to maintain strength + RoM as long as possible