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

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– 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