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Rheumatoid Arthritis

Rheumatoid Arthritis

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Published by: jobinbionic on Nov 01, 2008
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09/07/2012

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Rheumatoid arthritis
(
RA
) is a chronic,systemic autoimmune disorder that causes the immune systemto attack the joints, where it causes inflammation (arthritis
 
) anddestruction. It can also damage some organs, such as thelungsandskin. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. It is diagnosed with blood tests(especially a test called rheumatoid factor 
 
) andX-rays. Diagnosis and long-term management are typically performed by arheumatologist, an expert in the diseases of joints and connective tissues.
Various treatments are available. Non-pharmacological treatment includes  physicaltherapyand occupational therapy.Analgesia(painkillers) andanti-inflammatorydrugs, as well assteroids, are used to suppress the symptoms, whiledisease-modifying antirheumatic drugs(DMARDs) are often required to reverse the disease process and prevent long-term damage. In recent times, the newer group of  biologicshas increasedtreatment options.
The name is based on the term "rheumatic fever ", an illness which includes joint pain andis derived from the Greek word
rheumatos
("flowing"). The suffix -
oid 
("resembling")gives the translation as
 joint inflammation that resembles rheumatic fever 
. The firstrecognized description of rheumatoid arthritis was made in 1800 by Dr  Augustin JacobLandré-Beauvais(1772-1840) of Paris.
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[edit] Signs and symptoms
While rheumatoid arthritis primarily affects joints, problems involving all other organs of the body are known to occur. Extra-articular ("outside the joints") manifestations occur inabout 15% of individuals with rheumatoid arthritis.
It can be difficult to determinewhether disease manifestations are directly caused by the rheumatoid process itself, or from side effects of the medications commonly used to treat it - for example, lung fibrosisfrom methotrexate, or osteoporosis from corticosteroids.
[edit] Joints
The arthritis of rheumatoid arthritis is due to synovitis, which is inflammation of the synovial membrane that covers the joint. Joints become red, swollen, tender and warm,and stiffness prevents their use. By definition, RA affects multiple joints (it is a polyarthritis
 
). Most commonly, small joints of the hands, feet and cervical spine areaffected, but larger joints like the shoulder and knee can also be involved, differing per individual. Eventually, synovitis leads to erosion of the joint surface, causing deformityand loss of function.
Inflammation in the joints manifests itself as a soft, "doughy" swelling, causing pain andtenderness to palpation and movement, a sensation of localized warmth, and restrictedmovement. Increased stiffness upon waking is often a prominent feature and may last for more than an hour. These signs help distinguish rheumatoid from non-inflammatorydiseases of the joints such asosteoarthritis (sometimes referred to as the "wear-and-tear" of the joints). In RA, the joints are usually affected in a fairly symmetrical fashionalthough the initial presentation may be asymmetrical.Hands affected by RA
 
As the pathology progresses the inflammatory activity leads to erosion and destruction of the joint surface, which impairs their range of movement and leads to deformity. Thefingers are typically deviated towards the little finger (
) and can assumeunnatural shapes. Common deformities in rheumatoid arthritis are theBoutonnieredeformity(Hyperflexion at the proximal interphalangeal jointwith hyperextension at the distal interphalangeal joint),swan neck deformity(Hyperextension at the proximal interphalangeal joint, hyperflexion at the distal interphalangeal joint). The thumb maydevelop a "Z-thumb" deformity with fixed flexion andsubluxationat themetacarpophalangeal joint, and hyperextension at the IP joint.
[edit] Skin
The
is the cutaneous (strictly speaking subcutaneous) feature mostcharacteristic of rheumatoid arthritis. The initial pathologic process in nodule formationis unknown but is thought to be related to small-vessel inflammation. The mature lesion(a part of an organ or tissue which has been damaged) is defined by an area of centralnecrosis surrounded by palisading macrophagesandfibroblastsand a cuff of cellular  connective tissue andchronic inflammatory cells. The typical rheumatoid nodule may be a few millimetres to a few centimetres in diameter and is usually found over bony prominences, such as theolecranon,thecalcaneal tuberosity, the metacarpophalangeal  joints, or other areas that sustain repeated mechanical stress. Nodules are associated witha positive RF titer and severe erosive arthritis. Rarely, they can occur in internal organs.Several forms of 
 are also cutaneous manifestations associated with rheumatoidarthritis. A benign form occurs as microinfarcts around the nailfolds. More severe formsincludelivedo reticularis,which is a network (reticulum) of erythematous to purplish discoloration of the skin due to the presence of an obliterative cutaneous capillaropathy.Other, rather rare, skin associated symtoms include:
 pyoderma gangrenosum, a necrotizing, ulcerative, noninfectious neutrophilicdermatosis.
Sweet's syndrome, a neutrophilic dermatosis usually associated withmyeloproliferative disorders
drug reactions
lobular  panniculitis 
atrophyof digital skin
diffuse thinning (rice paper skin), and skin fragility (often worsened bycorticosteroid use).
[edit] Lungs
Fibrosisof the lungsis a recognised response to rheumatoid disease. It is also a rare but well recognised consequence of therapy (for example with methotrexate and

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