BIOM30002 Lecture Notes - Lecture 7: Rheumatoid Arthritis, Hyaline Cartilage, Synovitis
12 Jun 2018
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Topic 2 – Rheumatoid Arthritis
L7 Introduction to RA
Summary
Arthritis is not a single entity, burden of disease – heterogeneous
RA predominantly affects joints – extra-articular manifestations
Differentiating OA from RA – basis on distribution/pattern of joint involvement
Content
Arthritis
- joint inflammation
- affecting across all ages
- heterogeneous
- disability and reduce quality of life
- 95% of cases are
1. Osteoarthritis (OA)
2. Rheumatoid Arthritis (RA)
3. Gout (crystal arthritis)
- Age is one of the factor (more in ageing group)
- Prevalence approx.. 9%
- Cosy to treat, and indirect cost
Rheumatoid Arthritis (RA)
- Definition: chronic inflammatory autoimmune disease of unknown aetiology
- Includes:
1. Articular manifestation (dominant)
2. Extra-articular (systemic) complications
- Effect:
1. Progressive disability
2. Reduced life expectancy
3. Significant socioeconomic costs
- More common in females (2-3X), peak age onset: 40
Primary Manifestation of RA: Synovitis
- Synovitis = synovial inflammation
- Leads to erosion of bone, cartilage and peri-
articular structures
Clinical features
1. Morning stiffness: due to accumulation of
inflamed synovial fluid
2. Pain
3. Swelling
- Onset time various: insidious, intermediate and
acute
Articular manifestations
- Distribution of joint involvement:
1. Symmetrical
2. Commonly affect joints (small joints)
Upper limbs
Metacarpophalangeal (MCP)
Proximal interphalangeal (PIP)
Wrist (radiocarpal: diatal end
of radius + carpus)
Lower limbs
Metatarsophalangeal (MTP)
3. Characteristic deformities
Boutonniere (button hole):
fixed flexion deformity of PIP + fixed hyperextension of DIP
swelling
mechanism: protrusion of PIP through its ruptured extensor tendon
Swan neck (nearly converse of Boutonniere):
Fixed hyperextension of PIP + fixed flexion of DIP
Mechanism: flexor tendon rupture, lateral bands sublux dorsally at
the PIP joint and tendon shortening at the DIP joint
MCP subluxation and ulnar deviation
Z deformity (Z shaped shown in thumb):
Fixed flexion and subluxation of MCP +fixed hyperextension of the
interphalangeal joint of thumb
MCP subluxation: fingers slip downward
Ulnar deviation: fingers turning outwards
Radial wrist deviation
Document Summary
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