1. Rheumatoid Arthritis
By
Dr.Aseel Nuseirat
29/6/2013

2. Overview
 F > M 2.5: 1.
 Rheumatoid arthritis usually has a
slow, insidious onset over weeks to months
 Typical age of onset 30-50.
 RF +ve in 80-85 % / not specific.
 May 2 years before +ve.
 Accp / earlier / greater specificity for
diagnosis of RA.
 HLD-DR4 antigen  aggressive RA

3.  Rheumatoid arthritis is an autoimmune
disease in which the normal immune
response is directed against an individual's
own tissue, including the joints, tendons,
and bones, resulting in inflammation and
destruction of these tissues.

4. Functional Presentation and
Disability of RA
 In the initial stages of each joint
involvement, there is warmth, pain, and
redness, with corresponding decrease of
range of motion of the affected joint.
 Progression of the disease results in
reducible and later fixed deformities.
 Muscle weakness and atrophy develop early
in the course of the disease in many people.

5. 1. High RF.
2. Constitutional symptoms.
3. Insidious onset.
4. Early appearance of Rheumatoid nodule.
5. Early radiographic evidence of erossive
disease.
Severe cause probably with :

6. Signs & Symptoms
 Morning stiffness several hours
 fatigue
 low grade fever
 anorexia weight loss
 Symmetric involvement of Joints , hands
, MCPs , PIPs
 Boutonniere deformity  advanced RA
Flexion  PIP
Extension  DIP

7.  Hoarseness
 Sore throat + or.
 Neck pain  involvement of
cricoarytenoid C.
 Knee  most common single joint initially
involved RA.

8.  Carpal tunnel , tarsal funnel  RA.
 Pt with inflammatory Knee arthritis
present with swollen calf  ruptured
backer cyst causing pseudo phlebitis.
 Spine  C1-2 sublaxation separation of
atlanto- odontoid process by ≤ 3mm.

9.  Surgical fusion not needed for
asymptomatic c1-2 sublaxation.
 Pt with c1-2 sublaxation are susceptible
to trauma ass. With endo tracheal
intubations and present post surgery :
1- syncope
2- lightheadedness
3- nystagmus
 Therefore pt. with RA should do neck – x
ray before surgery.
 Lumber spine , SI joints spared

10. Diagnostic Criteria for RA
 ≤ 4 diagnosis of RA.
 Morning stiffness
 Arthritis of 3 or more joints
 Arthritis of hand joints
 Symmetric arthritis
 Rheumatoid nodules
 Serum rheumatoid factor
 Radiographic changes

11. Extra Articular Manifestation
 Cardiac :-
- Pericardities + Myocardities
- Rheumatoid nodules on the valves
- atherosclerosis – 3x risk ( sudden
death, MI).
 Renal :- ( very rare )
- Drug related renal disease.
- amyloid renal disease.

12.  Lung :-
- pleurisy with effusion exudate [ Glucose] (
low 20-30 ) LDH elevated.
- Diffuse interstitial fibrosis.
- intra pulmonary rheumatoid nodule.
 BLD :-
- anemia of chronic disease.
- neutropenia.

13.  Nerve :-
- mono neuritis multiplex foot or wrist
drop.
 Skin :-
- nodules  on extensor, 25%
 Vasculities :-
- May resemble pan.
- Necrosis & ulceration mostly on malleoli.

14.  Felly Syndrome :-
- RA + splenomegaly + Neutropenia ( can do
splenectomy )
 LGL Syndrome :-
- Neutropenia
- Splenomegaly
- Susceptibility to infection:
1- tend to LGL leukemia.
2- do not do splenectomy ( cause an exacerbation ).