Rheumatoid Arthritis

Question 1

Define Rheumatoid Arthritis

Answer 1

Chronic Inflammatory condition characterised by symmetrical deforming polyarthritis and extra-articular manifestations

Question 2

What is Rheumatoid Arthritis characterised by

Answer 2

1. Pain
2. Stiffness
3. Symmetrical synovitis (inflammation of the synovial membrane) of synovial (diarthrodial) joints

Question 3

Aetiology of Rheumatoid Arthritis

Answer 3

Autoimmune disease with unknown cause (Rheumatoid factor - IgM autoantibody against Fc portion of IgG)
Associated with other autoimmune phenomenon e.g. Raynaud’s, Sjrogens

Associated with HLA DR-1 and DR-4 haplotypes

Question 4

Risk factors for Rheumatoid Arthritis

Answer 4

50-55
Female
Family history
Smoking

Question 5

Symptoms of Rheumatoid Arthritis

Answer 5

Active symmetrical arthritis > 6 weeks (gradual onset | small joints | > 1 hour | relived with use | joint swelling + pain and tenderness | DIP usually spared)

Sub-cutaneous nodules, hard and painless
Morning stiffness
Weight loss
Fever
Pleuritic chest pain

Question 6

Signs of Rheumatoid Arthritis on examination

Answer 6

Early:
Spindling of fingers
MCP and PIP swelling + positive squeeze test
Warm, tender joints
Reduction in range of joint movement 

Late (poorly controlled):
Ulnar deviation
Rheumatoid nodules - firm, painless SC nodules (Elbows, palms, extensor tendons)
Swan neck deformity (MCP and DIP fixed flexion, PIP extension)
Boutonniere deformity (MCP and DIP joint extension, PIP flexion) - Z deformity
Symmetrical deforming arthropathy
Trigger finger (unable to straighten)
Waisting of small muscles of the hand
Joint effusions

Question 7

Investigations for Rheumatoid Arthritis

Answer 7

Rheumatoid factor: positive (70% at onset)
Anti-CCP antibodies: positie
ANA: positive

FBC: anaemia, thrombocytosis
CRP/ESR: raised

Joint X-ray: Joint space narrowing | osteopenia | erosive damage | joint deformity | soft tissue swelling