Rheumatoid Arthritis

What is it? Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease Cause is often unknown Usually affects synovial tissue of diarthrodial joints Systemic inflammation causes structural damage

Who is the most at risk? Women are 2-3 times more likely to be affected then men Most commonly between the ages of 20-40 years old Women who take oral contraceptives are less likely to acquire RA

Risk factors Although the exact mechanism is unknown Commonly believed risk factors include Genetics Environmental factors Hormones

Signs and Symptoms Symptoms begin gradually Weeks to months Morning stiffness over 45 minutes Duration of stiffness increases as the disease progresses May present as diffuse, bilateral joint pain and tenderness to palpation

Signs and Symptoms The acronym “SERIOUS” can help identify RA Swelling in one or more joints Early morning stiffness Recurring pain or tenderness in any joint Inability to move a joint normally Obvious redness and warmth in a joint Unexplained weight loss, fever, or weakness combined with joint pain Symptoms last more than 2 weeks * American Rheumatism Association Criteria for Classification of RA

Functional deficits Joint pain limits ability to: Walk C limb stairs Open doors ADLs

Radiographic imaging Joint erosion visible in 70-90% of individuals. Radiographic changes are often found on the posteroanterior aspect of the hands and wrist Bony decalcification in involved joints

Joints affected Cervical spine Shoulder Elbows Hands Hips Knees Ankles MTP and MCP joints especially Hips Knees Ankles

Extra-articular features Rhematoid nodules Arteritis Neuropathy Scleritis Pericarditis Lymphadenopathy Splenomegaly

What to do next? If the patient presents with these signs and symptoms and has not been diagnosed by a physician, a referral is warranted Serious health related problems can develop Aggressive medications and treatment will improve outcome