• Rheumatoid arthritis is an autoimmune inflammatory synovial disease
• Aetiology if unknown
• Worldwide prevalence is approximately 1%
• Female : male ratio is 3:1
• Onset most often seen between 20 and 40 years
• Usually symmetrically affects multiple joints
• Commonest joints affected are hand, elbow, knee and cervical spine
• Also affects synovium of tendon sheaths
• Often part of a systemic inflammatory process
• More common in those with HLA DR4 and DW4
• Pathologically characterised by:
  • An inflammatory process within the synovium
  • Joint destruction and pannus formation
  • Periarticular erosions

Clinical features

• Joint pain - worse during exercise
• Pain relieved by movement
• Prolonged early morning stiffness
• Prolonged stiffness after rest
• Marked soft tissue swelling and erythema
• Systemic features often present

Extra-articular manifestations
Occur in approximately 20% of patients

• Ocular
  • Keratoconjunctivitis sicca
  • Episcleritis
  • Scleritis
• Pulmonary
  • Pulmonary nodules
  • Pleural effusion
  • Fibrosing alveolitis
• Cardiac
  • Pericarditis / pericardial effusion
  • Valvular heart disease
  • Conduction defects
• Cutaneous
  • Palmar erythema
  • Rheumatoid nodules
  • Pyoderma gangrenosum
  • Vasculitic rashes and leg ulceration
• Neurological
  • Nerve entrapment
  • Cervical myelopathy
  • Peripheral neuropathy
  • Mononeuritis multiplex

Management

• Requires a multidisciplinary approach
• Disease modifying drugs include:
  • NSAIDs
  • Methotrexate, sulphasalazine, penicillamine, gold
  • Corticosteroids
  • Cytotoxic drugs

Specific syndromes

• Several syndromes have been described associated with rheumatoid arthritis
• Felty's syndrome
  • Rheumatoid arthritis
  • Neutropenia
  • Lymphadenopathy
  • Splenomegaly
• Still's disease
  • Rheumatoid arthritis in childhood
  • Rash
  • Fever
  • Splenomegaly
• Sjogren's syndrome
  • Rheumatoid arthritis
  • Reduced lacrimal and salivary secretion

Bibliography

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Gupta K B, Duryea J, Weissmann B N. Radiographic evaluation of osteoarthritis. Radiol Clin North Am 2004; 42: 1-9.
Haq I, Murphy E, Dacre G. Osteoarthritis. Postgrad Med J 2003; 79: 377-383.
Hunter D J, Felson D T. Osteoarthritis. BMJ 2006; 332: 639-342
Scott D L. Advances in the medical management of rheumatoid arthritis. Hosp Med 2002: 63: 294-297.
Walker-Bone K, Javaid K, Arden N, Cooper C. Medical management of osteoarthritis. Br Med J 2000; 321: 936-940.