RHEUMATOID ARTHRITIS
 
Commonest cause of chronic inflammatory joint disease.
 
Diagnostic criteria Symmetric polyarthritis and tenosynovities
 

Morning stiffness lasting for an hour

  Positive RA Factor
  Increased ESR
   
Cause Unknown
  Genetic predisposition
 
Clinical features  
Early Stages:

Women 30-40 years complain of pain, swelling and loss of mobility in proximal joints of the fingers. Later it spreads to the wrists, feet, knees and lastly the shoulder. Early morning stiffness. Symmetric distribution of swelling and tenderness of metacarpo-phalyngeal joints, the proximal interphalangeal joints and the wrists. Tenosynovitis in extensor compartments of the wrists (triggering of fingers).

   
Later Stages: Thickening of the joints
Reduced joint movements.
Deformities of the joint – maintaining involving hand, wrist, knee – knock
knees, feet (flat feet), clawed toes, tendon rupture.
   
Other features: Nodules over the extensor surface of the forarms and elbows. Lymphadenopathy. Nerve extrapment syndrome (like carpet tunnel syndrome, de Quervain’s disease, vasculities
   
X-Ray  
 Early stages:

Juxtra articular osteoporosis.
Soft tissue swelling.
Narrowing of articular space.

   
Late stage: Deformed joints.
   
Blood Investigation:

Increased ESR
Increased CRP
RA factor positive in 80% of the patients                             


Diagnosis
: Symmetric bilateral polyarticular involvement of the proximal joints of the hand or feet for more than 6 weeks with morning stiffness lasting more than 1 hour. Subcutaneous nodules or X-Ray signs in Diagnostic RA factor is a less important criteria.

However atypical presentations are very common.
Treatment:  
Early stages:

Stop swelling of joints (Synovities) – By painkillers and anti-inflammatory Drugs.
Keep the joints morning – Physiotherapy
Low dose steroids systemically in acute cases for a short times.
Intra-articular injection – controversial role.
Long term disease modifying drugs which involves Hydroxychloroquinine,
Leflunomide, Methotraxate, gold, Penicillamine

   
Later Stages:

To prevent contractures – Sphintages, Orthotic devices.                        Symovectomy tendon repairs and replacement, joint stabilization and osteotomies.

   
Very late Stages:

Joint Replacement.
Arthrodesis
Excision of joints

 
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