Rheumatoid Arthritis

from Rheumatoid Arthritis

Rheumatoid Arthritis is part of a systemic connective tissue disease with an insidious onset,  and a prolonged course marked by exacerbations and remissions of joint pain and swelling. As in this case, the patient often does not remember the first onset of symptoms. Rheumatoid arthritis effects about 1% of the population. Women are affected three times as frequently as men, and onset is usually in the patients thirties and forties. As in this case, there is usually symmetrical involvement of both hands.

The etiology of rheumatoid arthritis is unknown, although current theories lean toward a triggering event such as an infection in a genetically susceptible person, which unleashes an immune response which directly or indirectly destroys the synovial membranes, connective tissues and bone. Many patients with rheumatoid arthritis have HLA-DR4, and roughly 80% test positive for rheumatoid factor, a macroglobin molecule in the blood.

Clinically, the typical presentation is of symmetrical involvement of both hands, with morning pain and stiffness, swollen joints (particularly PIP, MCP, and wrist) and rheumatoid nodules (subcutaneous nodules that begin as vasculitis and become necrotic with fibrous, mononuclear and granulation tissues). In this case, the on the patient's forearm is a rheumatoid nodule. The underside (extensor surface) of the forearm distal to the elbow is a typical spot for rheumatoid nodules.

Radiographically, there is a typical presentation of bony erosion (white arrowheads). Progressive joint deformities (large white arrows) are due to muscle spasm, atrophy and contracture, as well as the erosion of articular surfaces, stretched ligaments and tendon rupture. In addition, pannus, a granular inflammation, creeps across the joint surfaces and chokes off the normal nutrient supply, causing cartilage necrosis, bone erosion, and ultimately the fusion of bones (ankylosis). This is seen as a lack of space around the carpal and metacarpal bones (black arrowheads).

Rheumatoid arthritis can be a terribly debilitating disease. The pain is treated with nonsteroidal anti-inflammatories, while the progress of the disease is hindered by exercise, physiotherapy and disease modifying anti-rheumatic drugs (DMARDs).

 

 

 

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