Which of the following is seen in Seropositive Rheumatoid Arthritis?
Multiple joints affected
Symmetrical joint symptoms
Morning stiffness, joint pain and swelling
All of the above
(D) All of the above[?]Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.It is the most common form of chronic inflammatory arthritis & often results in joint damage and physical disability.Because it is a systemic disease, RA may result in a variety of extraarticular manifestations, including fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis & hematologic abnormalities. Rheumatoid Arthritis Criteria (1987 revision, American Rheumatism Association):Morning stiffness (in/around joints, >1 hr before maximal improvement)Arthritis (swelling) of 3 or more joint areas (observed by physician)Symmetric arthritis (swelling, NOT bony overgrowth)Arthritis of Hand joints (wrists, MCPs or PIPs)Rheumatoid nodulesRheumatoid factor (serum)Radiographic changes (erosions and/or peri-articular osteopenia in hand/wrist joints)Requirements: >4 of the above 7 criteria. Criteria 1-4 must have been present for at least 6 weeks.Characteristic hand signs:Z-thumbs, Boutonniere, swan-necking, ulnar deviation, muscle wasting, subluxation of MCP, sometimes Carpal tunnel syndrome, Atlantoaxial subluxationExtra-articular features; Sjogren 'ds syndrome, Reynaud's, vasculitis. Nodules (firm but usually painless)Pathology: Auto-antibody production (70%IgM,30%IgG) against joint tissues.Investigations:Blood: RA factor positive. Rheumatoid factor is not diagnostic. Present in 70%, but also in general population. Rheumatoid positive disease has worse prognosis and more extensive deformity. Anti-CCP antibodies test similar to rheumatoid factor, | ESR + | CRP, normochromic-normocytic anaemia common.X-ray: look for nodules, soft-tissue swelling, osteopaenia, deformity, erosions.Treatment:Aim to reduce long-term deformity & LoF. Steroids induce remission, beware SE's long termDMARDs are mainstay. All can cause myelosuppression and rash plus: Sulfasalzine: hepatic impairment, oligospermia, methotrexate; GI disturbance (give folic acid to reduce), mouth ulcers, hepatic impairment gold; medical emergency rash, photosensitivity, nephrotic syndrome; leflunomide, chloroquine: retinitis, tinnitus, infliximab; anti TNF- a agent: can cause reactivation of latent diseases (e.g. TB).
Arthritis