Rheumatoid arthritis

Rheumatoid arthritis



Rheumatoid arthritis
Rheumatoid arthritis is a chronic systemic disease leading to symmetrical inflammatory polyarthritis affecting mainly peripheral joints with progressive joint damage; also it is associated with extra-articular manifestations.


Rheumatoid arthritis is the most common inflammatory arthritis and hence an important cause of potentially preventable disability.


Aetiology:

Rheumatoid arthritis is an autoimmune disease. The cause of rheumatoid arthritis is not known. Many factors are involved in the abnormal activity of the immune system that characterizes rheumatoid arthritis. These factors include genetics (heredity), hormones (explaining why the disease is more common in women than men), and possibly infection by a bacterium or virus.


Signs and symptoms:

1- Musculoskeletal: · Painful, swollen, stiff joints
· Effusion in large joints
· Morning stiffness
· Joint deformities as ulnar deviation, swan neck, Z deformity … etc.
· Other manifestations as bursitis, periarticualr osteoporosis, muscle wasting.


2- Skin:· Subcutaneous nodules
· Raynaud’s phenomenon
· Palmar erythema
· Skin fragility
· Sweet’s syndrome


3- Lungs and respiratory tract:· Circoartenoid arthritis causing hoarseness of voice
· Pleural effusion
· Pulmonary nodules
· Caplan’s syndrome if combined with pneumoconiosis
· Pulmonary vasculitis
· Bronchiolitis


4- Kidneys:· Glomerulonephritis caused by drugs
· Amyloidosis kidney


5- Heart and blood vessels:· Atherosclerosis
· Pericarditis
· Myocarditis
· Endocarditis
· Valvulitis
· Conduction defects
· Blood vessels vasculitis and coronary arteries vasculitis


6- Eyes:· Scleritis
· Episcleritis
· Uveitis
· Iritis
· Perforating scleromalacia
· Keratoconjuncitivitis sicca


7- Liver, spleen and lymph nodes:· Nodular hyperplasia in the liver
· Spleen enlargement
· Increased incidence of lymphoma


8- Blood : · Normocytic normochromic anemia
· Iron deficiency anemia
· Thrombocytosis
· Neutropenia


9- Nerves : · Entrapment neurophathies as median nerve compression causing carpal tunnel syndrome
· Polyneuropathy and mononeuritis multiplex
· Sudden death due to cervical cord compression


10- Constitutional symptoms: · Fever
· Malaise
· Weight loss
· Easy fatigue
· Loss of appetite


Diagnosis:-

Criteria of rheumatoid arthritis:At least 4 criteria must be present for 6 weeks
1- Morning stiffness for more than one hour
2- Arthritis of more than 2 joints
3- Arthritis of hand joints sparing distal pharynges
4- Arthritis is symmetrical
5- Rheumatoid nodules
6- Positive Rheumatoid factor
7- Typical radiological changes


Differential diagnosis:1- Gout and pseudogout
2- Osteoarthritis
3- Systemic lupus
4- Viral arthritis
5- Connective tissue diseases


Imaging:
X-ray
X-ray shows soft tissue swelling and narrow joint space in the early stages but it shows deformity and ankylosis later.
Other medical imaging techniques are also used in diagnosis of rheumatoid arthritis as magnetic resonance imaging, ultrasound and CT scan.


Blood tests:Rheumatoid factor is positive in 80% of cases
Anti CCP is positive in 80% of cases
ANA positive in 20% of cases
Normocytic normochromic anemia
Increased ESR especially in severe cases
Increased C-reactive protein
Synovial fluid shows decreased level of protein, glucose and complement.


Treatment:-

There is no known cure for rheumatoid arthritis but many different types of treatment can modify disease process or decrease symptoms.


NSAIDs: to relieve pain and stiffness through inhibition of cyclooxygenase enzyme.
Glucocorticoids: to slow the rate of radiological progression.
DMARDs: to decrease progression of erosive changes and decrease activity of the disease.
Biological therapy: to control disease activity and prevent joint damage
Surgical: to correct deformity, decompress nerves, repair tendons … etc.
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