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
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.
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.
1. High RF.
2. Constitutional symptoms.
3. Insidious onset.
4. Early appearance of Rheumatoid nodule.
5. Early radiographic evidence of erossive
Severe cause probably with :
Sore throat + or.
Neck pain involvement of
Knee most common single joint initially
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.
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 :
Therefore pt. with RA should do neck – x
ray before surgery.
Lumber spine , SI joints spared
Diagnostic Criteria for RA
≤ 4 diagnosis of RA.
Arthritis of 3 or more joints
Arthritis of hand joints
Serum rheumatoid factor
Extra Articular Manifestation
- Pericardities + Myocardities
- Rheumatoid nodules on the valves
- atherosclerosis – 3x risk ( sudden
Renal :- ( very rare )
- Drug related renal disease.
- amyloid renal disease.
- mono neuritis multiplex foot or wrist
- nodules on extensor, 25%
- May resemble pan.
- Necrosis & ulceration mostly on malleoli.
Felly Syndrome :-
- RA + splenomegaly + Neutropenia ( can do
LGL Syndrome :-
- Susceptibility to infection:
1- tend to LGL leukemia.
2- do not do splenectomy ( cause an exacerbation ).