RHEUMATOLOGY

MUSKULOSKELETAL SYSTEM
CASE
Chronic, systemic, inflammatory
autoimmune disorder that mainly
DEFINITION affects the joints but may also A 42-year-old woman comes to the physician because of an 8-month
manifest with extraarticular features.
history of intermittent pain & stiffness in her hands & feet. Episodes
occur about x 3 a month after she wakes up & last for 1 hour. They are
sometimes accompanied by fever & myalgia. She takes ibuprofen
during the episodes, which provides pain relief. She had her last
attack 5 days ago. She is otherwise healthy & takes no medications.
- > 65 years
- Sex:  >  Vital signs are within normal limits. Examination shows mild swelling
- Obesity & tenderness of the wrists & the proximal interphalangeal joints of
RISK FACTORS - Genetic disposition:HLA-DR4 + HLA
DR1 both hands. What is your most likely diagnosis?
- +ve Family History
- Environmental factors (e.g:smoking)
- Hormonal factors
- Infection

PATHOGENESIS

MANAGEMENT

© Davidson's Principles and Practice of Medicine

. (24th Edition)

Commonly Affected Joints:

- MCP joints
Symmetrical Polyarthralgia - PIP joints
- Wrist joints
- Knee joints

Morning stiffness >30min

RHEUMATOID ARTHRITIS

.
Swan Neck Deformity PIP hyperextension & DIP flexion

Boutonniere deformity PIP flexion & DIP hyperextensio

hyperextension of the interphalangeal

Hitchhiker thumb deformity
joint with fixed flexion of the MCP
(Z deformity of the thumb)
joint

Glucocorticosteroids &/OR NSAIDs Acute Flares Ulnar deviation

Articular Manifestations
Piano key sign dorsal subluxation of the ulna

Hammer toe or claw toe

Atlantoaxial subluxation

Joint deformities
©AMBOSS

CLINICAL PRESENTATION Painful compression of hands or

Long-term treatment feet at the level of the MCP joint.

TREATMENT

Gaenslen squeeze test

Joint Replacement

Synovectomy Surgical Treatment

Extra-Articular Manifestations
Radiation synovectomy

©Malvika Gulati,Ziad Farah,Maria Mouyis,

Clinical features of rheumatoid arthritis,
Medicine,18|doi.org/10.1016/j.mpmed.2018.01.008

- Low-grade fever
- Myalgia
- Malaise SCAN ME
Constitutional Symptoms
- Fatigue
- Weight loss
- Night sweats
REFERENCES: DAVIDSON’S PRINCIPLES OF MEDICINE (24TH ED) | STEP-UP TO MEDICINE (2ND ED) | AMBOSS SCAN ME