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Rheumatoid Arthritis Symptoms and Diagnosis

Rheumatoid Arthritis Symptoms
Rheumatoid Arthritis

Rheumatoid Arthritis

What is Rheumatoid arthritis – Rheumatoid arthritis (RA) is one of autoimmune diseases which is a chronic or long-term inflammatory condition. RA is the commonest chronic inflammatory polyarthritis and affects about 3% of the population. The symptoms develop gradually, and can vary from a mild to a most severe debilitating expression. It may include joint pain, stiffness, and swelling. The condition can affect many tissues throughout the body, but the joints are usually most severely affected. The cause of rheumatoid arthritis is unknown.

RHEUMATOID ARTHRITIS RISK FACTORS – The particular cause of rheumatoid arthritis is still not known yet. Susceptibility factors and Initiating factors, however, have been suspected as factors that can affect a person’s risk.

Susceptibility factors – RA most likely develops when a susceptible person is exposed to factors that start the inflammatory process. Heredity, gender, and genes mostly determine a person’s chance of developing rheumatoid arthritis. Approximately 1 per 100 individuals has rheumatoid arthritis.

Heredity – RA is not an inherited disease. Genes do not cause rheumatoid arthritis, they only affect the risk of disease’ development.
Gender – Gender seems to participate in a major role in a person’s susceptibility to rheumatoid arthritis. Females are about 3 times more likely than males.
Specific genes – Person with certain variants of human leukocyte antigen (HLA) genes are more likely to acquire rheumatoid arthritis.
Initiating factors – Many people who have HLA genes never develop the disease. In fact, when one identical twin has rheumatoid arthritis, the likelihood that the other will develop disease is only about 1 in 3. This indicates that other factors must be necessary for a person to develop RA.

Infection – Bacteria or viruses may be one of the factors that initiate rheumatoid arthritis.
Cigarette smoking – Cigarette smoking may increase the risk of developing RA and also can increase the likelihood the severity should it occurs.
Stress – Stressful events such as accidents, divorce and grief are more common in people with RA in the six months prior their diagnosis.

RHEUMATOID ARTHRITIS SYMPTOMS – In most people RA begins with the insidious onset of pain and stiffness of the small joints of the hands and feet which is on-going rather than fleeting and mainly affects the fingers where symmetrical involvement of the PIP joints produces spindling while the metacarpophalangeal joints (joints in the middle of the fingers) develop diffuse thickening as does the wrist. Early symptoms may include fatigue, muscle pain, a low-grade fever, weight loss, and numbness and tingling in the hands. In some cases, these symptoms occur before joint pain or stiffness is noticeable. In 25% of cases RA presents as arthritis of a single joint such as the knee, a situation leading to confusion with Lyme disease or a spondyloarthropathy.

rheumatoid arthritis pictures, rheumatoid arthritis symptoms,

Joints involved

Hands : MCP and PIP joints, DIP joints (30%)
Wrist and elbows
Feet : MTP joints, tarsal joints (not IP joints), ankle
Knees (common) and hip (delayed—up to 50%)
Shoulder (glenohumeral) joints
Temporomandibular joints
Cervical spine
Joint symptoms – Usually begin gradually and include pain and stiffness, redness, warmth to the touch, and joint swelling. The joint stiffness is most bothersome in the morning and after sitting still for a period of time. The stiffness can persist for more than one hour.

rheumatoid arthritis symptoms

Hands – The joints of the hands are often the very first joints affected by rheumatoid arthritis. Between 1 and 5 % of people with rheumatoid arthritis develop carpal tunnel syndrome because swelling compresses a nerve that runs through the wrist which is characterized by weakness, tingling, and numbness of certain areas of the hand.
Certain characteristic hand deformities can occur with long-standing rheumatoid arthritis. swan neck deformities and boutonniere deformities, and may drift together in the direction of the small finger. The tendons on the back of the hand may become very prominent and tight, called the bow string sign.

Wrist – The wrist is the most commonly affected joint of the arm in people with rheumatoid arthritis. In the early stages of rheumatoid arthritis, it may become difficult to bend the wrist backward.
Elbow – Rheumatoid arthritis may cause inflammation of the elbow. Swelling of this joint may compress nerves that travel through the arm and cause numbness or tingling in the fingers.
Shoulder – The shoulder may be inflamed in the later stages of rheumatoid arthritis, causing pain and limited motion.
Foot – The joints of the feet are often affected in the early stages of rheumatoid arthritis, especially the joints at the base of the toes.
Ankle – Rheumatoid arthritis may cause inflammation of the ankle. Inflammation of this joint may cause nerve damage, leading to numbness and tingling in the foot.

Knee – Rheumatoid arthritis may cause swelling of the knee, difficulty bending the knee, excessive looseness of the ligaments that surround and support the knee, and damage of the ends of the bones that meet at the knee. RA may cause the formation of a Baker’s cyst (a cyst filled with joint fluid and located in the hollow space at the back of the knee).
Hips – The hips may become inflamed in the later stages of rheumatoid arthritis. Pain in the hips may make it difficult to walk.
Cervical spine – Rheumatoid arthritis may cause inflammation of the cervical spine, which is the area between the shoulders and the base of the head.
Cricoarytenoid joint -In about 30 % of people with rheumatoid arthritis, there is inflammation of a joint near the windpipe called the cricoarytenoid joint. Inflammation of this joint can cause hoarseness and difficulty breathing.
Other symptoms – Although joint problems are the most commonly known issues in rheumatoid arthritis, the condition can be associated with a variety of other problems.

Rheumatoid nodule – Rheumatoid nodule is painless lumps that appear beneath the skin. The nodule may move easily when touched or they may be fixed to deeper tissues.
Felty’s Syndrome : Characterized by an abnormally enlarged spleen (splenomegaly).
Amyloidosis : Infiltration of the liver, kidneys, spleen and other tissues with amyloid (starch like substance).
Inflammatory conditions – Rheumatoid arthritis may produce a variety of other symptoms, depending on which tissues are inflamed.
Pericarditis : Inflammation of the pericardium, tissue lining the chest cavity and surrounding the heart that may cause chest pain and difficulty breathing.
Fibrosing Alveolitis : Inflammation of the lung that is not due to infection may cause shortness of breath and a dry cough.
Peripheral sensory neuropathy, mononeuritis multiplex : Abnormal nerve function may cause numbness, tingling, or weakness.
Sjögren’s syndrome : Dry eyes and dry mouth. women may develop vaginal dryness due to Sjögren’s syndrome, which can cause pain with sexual intercourse.
Inflammation of the white part of the eye may cause pain or vision problems.
Vasculitis – Inflammation of the blood vessels, may cause a wide variety of symptoms, depends on the location.
RHEUMATOID ARTHRITIS DIAGNOSIS – There is no single test used to diagnose rheumatoid arthritis. Instead, the diagnosis is based upon many factors, including the characteristic signs and symptoms, the results of laboratory tests, and the results of x-rays.

American Rheumatism Association: criteria for the diagnosis of rheumatoid arthritis

Morning stiffness
Pain on motion or tenderness in at least one joint
Swelling of one joint, representing soft tissue or fluid
Swelling of at least one other joint (soft tissue or fluid) with an interval free of symptoms no longer than three (3) months
Symmetrical joint swelling (simultaneous involvement of the same joint, right and left)
Subcutaneous nodules over bony prominences, extensor surfaces or near joints
Typical X-ray changes that must include demineralisation in periarticular bone as an index of inflammation
Positive test for rheumatoid factor in the serum
Synovial fluid – a poor mucin clot formation on adding synovial fluid to dilute acetic acid

  1. Synovial histopathology consistent with RA:

(a) marked villous hypertrophy

(b) proliferation of synovial cells

(c) lymphocyte plus plasma cell infiltration in subsynovium

(d) fibrin deposition within or upon microvilli

  1. Characteristic histopathology of rheumatoid nodules biopsied from any site

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