Rheumatoid Hand - Kate Owers 20/1/2005
Definitions of
Rheumatoid Arthritis
Burge " "a distal symmetrical small-joint polyarthropathy that typically affects the PIP and MCP joints of hands, wrists, ankles, MTPJs, knees and C spine " primarily a disease of the synovium but has systemic manifestations"
Burge " "a distal symmetrical small-joint polyarthropathy that typically affects the PIP and MCP joints of hands, wrists, ankles, MTPJs, knees and C spine " primarily a disease of the synovium but has systemic manifestations"
Burge " "a distal symmetrical small-joint polyarthropathy that typically affects the PIP and MCP joints of hands, wrists, ankles, MTPJs, knees and C spine " primarily a disease of the synovium but has systemic manifestations"
Features
Commonest form of inflammatory arthritis (reported prevalence 1-3%) Autoimmune 3F:1M, starts insidiously 4 th -5 th decade, genetic predisposition
DD: SLE, Psoriatic arthropathy, crystal deposition, spondyloarthritides
Diagnosis
: primarily clinical
- although RhF (IgM autoantibody to IgG) often +ve.
Rose-Waller or Latex agglutination tests
Diagnostic criteria
(American Rheumatological Assoc 1987)
³
4/7 criteria for >6/52:
1.
Morning stiffness >1 hr
2.
Arthritis
³
3 joint areas (R+L " PIP, MCP, wrist, elbow, knee, ankle, MTP = 14)
3.
Arthritis of hand joints (wrist, MCPJ or PIPJ)
4.
Symmetrical arthritis
5.
Rheumatoid nodules (granulomata composed of central fibrinoid necrosis, cellular debris & monocytes, prob 2 º to small vessel vasculitis) " extensor surface of joints
6.
Rheumatoid Factor (70-80% +ve " JRA 25%)
7.
Radiological changes i.e.
i.
ST swelling
ii.
Cartilage loss
®
joint space narrowing
iii.
Periarticular erosions
iv.
Subchondral osteopenia
Manifestations:
o
3 pathological stages (Apley)
Stage 1 'synovitis'
-
soft tissue swelling and periarticular osteopenia
-
vascular congestion, synovial villous formation
-
capsular thickening, painful, swollen joints
Stage 2 'destruction'
-
narrowing joint space + erosions by proteolytic enzymes + pannus of granulation tissue in synovial reflections
-
also affects tendon sheaths -
'synovium destroys cartilage and tendons'
(vs. OA)
Stage 3 'deformity'
-
articular destruction
-
capsular stretching
-
tendon ruptures
o Vascular e.g. vasculitis, Raynaud's
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