Musculoskeletal System >
Rheumatoid Arthritis (RA)

“A systemic autoimmune disease that primarily causes chronic inflammation of joints

Risk Factors
  • Modifiable:
    • Smoking
  • Non-Modifiable:
    • Age (usual onset 40-60)
    • Sex (female)
    • Family history
    • Genetic susceptibility
    • Infection
Aetiology
  • Unclear, multifactorial: thought to be caused by genetic susceptibility or infection
Pathophysiology
  • Thought to involve a type III hypersensitivity reaction (immune complex deposition)
  • Autoantibodies (e.g. rheumatoid factor, anti-CCP) attack the synovium → inflammation and hyperplasia of the synovium → destruction of the underlying cartilage and bone
Clinical Presentation
  • Symmetrical, inflammatory polyarthritis, usually affecting hands, wrists and feet
  • Patients may report joint pain, stiffness, swelling, tenderness and reduced ROM
  • Extra-articular symptoms include rheumatoid nodules, malaise, fatigue, fever
  • Symptoms occur in flare-ups and worse in morning / following periods of inactivity
  • Can eventually result in bone erosion, joint deformity and disability
Investigations
  • Diagnosis is based on history, examination, blood tests (ESR, CRP, FBC, rheumatoid factor, anti-CCP) and imaging of joints (X-ray / MRI).
  • No test can fully prove or rule out a diagnosis
Management
  • Symptomatic relief: analgesia (paracetamol), NSAIDs (ibuprofen, celecoxib), GCS
  • DMARDs to slow disease progression (methotrexate, leflunomide, sulfasalazine)
  • Biological DMARDs for those that don’t respond (rituximab, infliximab)
  • May require surgery (synovectomy / joint replacement) and physiotherapy
Complications
  • Osteoporosis (may be caused by RA itself or medications)
  • Pleurisy / pulmonary fibrosis
  • Pericarditis
  • Increased risk of infection
  • Lymphoma
  • Sjogren’s syndrome
  • Vasculitis

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