Rheumatoid Arthritis

  • especially synovial joints
  • HLA-DR4

Pathogenesis

  • synovium important for lubrication
  • RA: inflammation of synovium

  • pannus can erode into cartilage, bone, destroy joint

  • pink: thin layer of synovial cells that can be inflammed
  • thickens: pannus, eat down into cartilage and bones

Symptoms

  • osteoarthritis: not symmetric
  • morning stiffness with arthritis resolves in less than an hour
  • osteoarthritis: more you use, more it hurts, no fever

  • top: DIP, spared
  • middle: PIP
  • bottom: MCP
  • picture: painful, swollen, redness

  • wrist deviate toward ulnar side
  • pic: swan neck

Systemic Complications

  • outside of joints
  • swollen in back of knee
  • rupture: pain travel down knee

  • pleura around lungs or pericardium around heart

  • aka rheumatoid nodules
  • central necrosis surrounded by pallisading macrophages/lymphocytes

  • secondary sjogren syndrome
  • sjogren also association with lupus

Diagnosis

  • citrullinated peptides: peptides with citrulline added
  • IgM against IgG

Treatment

  • short term/rapid onset with NSAIDS and steroids
  • DMARDS: modern treatment. Protect joints from destruction

Sulfasalazine

  • 5 ASA similar to aspirin, similar effect

Leflunomide

Infliximab

  • Etanercept looks just like TNF receptors

Association

  • rare complication
  • triad: splenomegaly, neutropenia, RA