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RHEUMATOID ARTHRITISDescription
(
RA
) is a chronic,systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatorysynovitis,serositis (inflammation of the lining surfaces of the joints, pericardium, and pleura),rheumatoid nodules, and vasculitis that often progresses to destruction of the articular cartilage andankylosisof the joints. Rheumatoid arthritis can also produce diffuseinflammation in thelungs,pericardium,pleura,andsclera, and also nodular lesions, most common in subcutaneous tissue under theskin. Although the cause of rheumatoidarthritis is unknown,autoimmunityplays a pivotal role in its chronicity and progression.The hallmark feature of the disease is persistent symmetric polyarthritis(synovitis) that affects the hands and feet, although any joint lined by a synovialmembrane may be involved. In addition to articular deterioration, systemic involvementmay lead to weight loss, low-grade fever, and malaise. The severity of RA may fluctuateover time, but chronic RA most commonly results in the progressive development of various degrees of joint destruction, deformity, and a significant decline in functionalstatus.
AKA 
RA ( Rheumatic Arthritis )
INCIDENCES
About 1% of the world's population is afflicted by rheumatoid arthritis, womenthree times more often than men. Onset is most frequent between the ages of 40 and50, but no age is immune.The prevalence rate of rheumatoid arthritis is approximately1% of the population (range 0.3-2.1%)A study from Denmark investigated whether the higher rate of RA amongwomen could be linked to certain reproductive risk factors.
 
Reviewing the cases of menand women who had been hospitalized with RA between 1977 and 2004, the authorsfound that the rate of RA was higher in women who had given birth to just 1 child than itwas in women who had delivered 2 or 3 offspring. (However, no increased rate wasfound in women who were nulliparous or who had a history of lost pregnancies.)The study also found a higher RA risk among women with a history of preeclampsia,hyperemesis during pregnancy, or gestational hypertension. The authors suggestedthat this portion of the data indicated that a reduced immune adaptability to pregnancymay exist in women who have a predisposition to the development of RA or that theremay be a link between fetal microchimerism (in which fetal cells are present in thematernal circulation) and RA.Although rheumatoid arthritis (RA) can occur at any age, the incidence increaseswith advancing age. The peak incidence of RA occurs in individuals aged 40-60 years.
 
RISK / PREDISPOSING FACTORS
•
Blood TransfusionsYou may have an increased risk of developing rheumatoid arthritis if you havereceived blood transfusions.
•
AgeAlthough rheumatoid arthritis can develop at any age, you’re most likely todevelop the condition between the ages of 25 and 45.
•
Gender Women are 2.5 to 3 times more likely to develop rheumatoid arthritis thanmen.
•
Genetic FactorsYou are more likely to develop rheumatoid arthritis if there are other people inyour family with this condition or with other autoimmune disorders.
•
Ethnic BackgroundYou have a greater risk of developing rheumatoid arthritis if you are:
White
Native American (particularly belonging to the Yakima, Chippewa, or Inuit tribes)
•
WeightPeople who are obese may have an increased risk of developing rheumatoidarthritis.
•
Coffee and CigarettesSome studies have suggested that there is a connection between drinkingcoffee and developing rheumatoid arthritis. More work needs to done to confirm thisassociation.Long-term smoking may be a risk factor for the development of rheumatoidarthritis.
MANIFESTATION
 
Early phase of the disease is characterized by the following features:
•
Joint swelling that may affect joint margins
•
Joint tenderness upon palpation
•
Systemic malaise
•
Loss of energy
•
Severe morning stiffness that limits function and generally lasts more than anhour.
TYPE OF RHEUMATOID ARTHRITIS
•
Juvenile rheumatoid arthritis (JRA)
is the most common form of childhoodarthritis. The cause remains unknown. For most patients, the immunogenicassociations, clinical pattern, and functional outcome are different from adultonset RA.Ankylosis inthe cervical spine atseveral levels dueto long-standing juvenile rheumatoidarthritis (also knownas juvenileidiopathic arthritis).Widespread osteopenia, carpal crowding (due tocartilage loss), and several erosions affecting the carpalbones and metacarpal heads in particular in a child withadvanced juvenile rheumatoid arthritis (also known as juvenile idiopathic arthritis)The diagnostic criteria for JRA are onset occurring when younger than 16 years,persistent arthritis in 1 or more joints for at least 6 weeks, and exclusion of other typesof childhood arthritis. The key points that characterize the diagnosis of JRA are asfollows:
•
Arthritis must be present. Arthritis is defined as the presence of swelling, thepresence of effusion, or the presence of 2 or more of the following signs: limitedrange of motion (ROM), tenderness, pain on motion, or joint warmth.
•
Arthritis must persist for at least 6 weeks.
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