RHEUMATOLOGY

Classification of Arthritis:

1. Inflammatory
-RA
-Polymyalgia Rheumatica
-SLE
2. Non-inflammatory
-OA: MC non-inflammatory MSK condition in the elderly
3. Crystal-induced
-Gout
-Pseudogout
4. Spondyloarthropathies
-Psoriatic Arthritis
-Ankylosing Spondylitis
-Reactive Arthritis/ Reiter’s Dse
-Inflammatory Bowel Dse

Rheumatoid Arthritis

F>M, 35-45 y/o: Small joints- Polyarthritis

F=M, >60 y/o: Large joints- Oligoarthritis (few joints are affected)

Hallmark- Morning Stiffness & Joint pain

Systemic- has extraarticular manifestations (MC: Rheumatoid Nodules)

Inflammatory- synovium of the diarthrodial jts are affected

Theories of Pathophysiology
 Abnormal T-cell functioning- autoimmunity
 Positivity of bacterial/viral infection
 Positivity of Rheumatoid Factor
 Positivity in HLA-DR4
 Proliferation of T-Cells; Erosion, Pannus Formation- destruction of jt. structures

1987 American Rheumatology Association Criteria (4 out of 7 for 6 weeks)

Criterion Definition
1. Morning stiffness- Morning stiffness in and around the joints, lasting at least 1 hour before maximal
improvement
2. Arthritis of 3 or more joint areas- At least 3 joint areas simultaneously have had soft tissue swelling or fluid (not
bony overgrowth alone) observed by a physician. The 14 possible areas are right or left PIP, MCP, wrist, elbow,
knee, ankle, and MTP joints

3. Arthritis of hand joints - At least 1 area swollen (as defined above) in a wrist, MCP, or PIP joint

4. Symmetric arthritis- Simultaneous involvement of the same joint areas (as defined in 2) on both sides of the
body (bilateral involvement of PIPs, MCPs, or MTPs is acceptable without absolute symmetry)

5. Rheumatoid nodules- Subcutaneous nodules, over bony prominences, or extensor surfaces, or in juxtaarticular
regions, observed by a physician

6. Serum rheumatoid factor- Demonstration of abnormal amounts of serum rheumatoid factor by any method for
which the result has been positive in <5% of normal control subjects

7. Radiographic changes- Radiographic changes typical of rheumatoid arthritis on posteroanterior hand and wrist
radiographs, which must include erosions or unequivocal bony decalcification localized in or most marked adjacent
to the involved joints (osteoarthritis changes alone do not qualify)

POOR PROGNOSIS
-Symmetrical
-Female
-Early multiple jt. effusions
-Early appearance of subcutaneous nodules

Most Commonly Jts affected from greatest to least:

MCP>Wrist>PIP>Knee>MTP>Sh>Ankle>Cervical>Hip>Elbow>TMJ
“Mama Wants PIP KM SACHET”

Swan Neck Deformity

-PIP ext, DIP flex
-rupture of lat bands of ext hood
-may also be d/t reflex ms spasm of instrincs
-swelling of volar capsule of PIP jt
-pulls ext hood and may cause rupture of lat band
-rupture of EDC @ DIP: Mallet Finger- DIP flex
Buotonniere Deformity Cervical Spine
-DIP ext, PIP flex -segment: C1-c2
-rupture of central slip -LOM: Rot
-Sublux atlantoaxial; CI: traction machine
Arthritis Mutilans
-severe destruction of jts leading to severe deformity Hip
of hand -Protruded acetabulum
-Trendelenburg gait
Ulnar Drift -LOM: IR
-involves wrist & MCP d/t D/L of ECU tendon -Referral pain: groin area
-wrist RD + MCP deviates to ulnar side
-“Z deformity” or Zigzag deformity Elbow
-(+) intrinsic-plus deformity -flexion contracture
-loss of sup & pron
Vaughn-Jackson Deformity
-rupture of ext. tendons of 4th & 5th digits TMJ
-limitation of mouth opening
Mannerfelt Deformity -protrusion & side to side remain Normal
-rupture of FPL tendon- MC ruptured tendon of the
hand in RA
-Buotonnier thumb

Knee Joint Deformity

-Flexion contracture
-Baker’s Cyst
-Patellar Subluxation

MTP Jt Deformities
-metatarsalgia
-Hammer toes- MC foot deformity in RA, PIP flex +
DIP maybe straight or ext
-Claw toes
-Hallux Valgus

Shoulder
-subluxation
-LOM
-ADIR deformity

Ankle
-Post subluxation
-Hindfoot pronation
-Flatfoot: collapse MLA
-Splayfoot: collapse Transverse Arch