Rheumatoid arthritis Health Dictionary

Rheumatoid Arthritis: From 3 Different Sources

A type of arthritis in which the joints in the fingers, wrists, toes, or elsewhere in the body become painful, swollen, stiff, and, in severe cases, deformed. Tissues outside the joints, such as the heart, can also be affected. Rheumatoid arthritis is an autoimmune disorder that usually starts in early adulthood or middle age but can also develop in children (see juvenile chronic arthritis) or elderly people. Women are affected more often than men. There are usually recurrent attacks.

Symptoms are mild fever and aches followed by swelling, redness, pain, and stiffness in the joints. Ligaments, tendons, and muscles around the joint may also become inflamed. Raynaud’s phenomenon may occur in the fingers, and swelling of the wrist may cause carpal tunnel syndrome and tenosynovitis. Complications caused by severe rheumatoid arthritis include pericarditis, ulcers on the hands and feet, pleural effusion, pulmonary fibrosis, and Sjögren’s syndrome.

A diagnosis can be confirmed through X-rays and blood tests. Treatments include non-steroidal anti-inflammatory drugs (NSAIDs); antirheumatic drugs, such as gold, penicillamine, or sulfasalazine; and immunosuppressants, such as azathioprine or corticosteroids. Corticosteroid drugs may also be injected into the joints.

Physiotherapy is needed to prevent or limit deformity or to help relieve symptoms and maintain mobility. People who are disabled by arthritis can be helped to cope with everyday tasks through occupational therapy.

In severe cases, surgery may be performed to replace damaged joints with artificial ones (see arthroplasty).

Most sufferers must take drugs for life, but many can achieve a near-normal level of activity with effective control of symptoms.

Health Source: BMA Medical Dictionary
Author: The British Medical Association

A chronic in?ammation of the synovial lining (see SYNOVIAL MEMBRANE) of several joints, tendon sheaths or bursae which is not due to SEPSIS or a reaction to URIC ACID crystals. It is distinguished from other patterns of in?ammatory arthritis by the symmetrical involvement of a large number of peripheral joints; by the common blood-?nding of rheumatoid factor antibody; by the presence of bony erosions around joints; and, in a few, by the presence of subcutaneous nodules with necrobiotic (decaying) centres.

Causes There is a major immunogenetic predisposition to rheumatoid arthritis in people carrying the HLA-DR4 antigen (see HLA SYSTEM). Other minor immunogenetic factors have also been implicated. In addition, there is a degree of familial clustering which suggests other unidenti?ed genetic factors. Genetic factors cannot alone explain aetiology, and environmental and chance factors must be important, but these have yet to be identi?ed.

Epidemiology Rheumatoid arthritis more commonly occurs in women from the age of 30 onwards, the sex ratio being approximately 4:1. Typical rheumatoid arthritis may occur in adolescence, but in childhood chronic SYNOVITIS usually takes one of a number of di?erent patterns, classi?ed under juvenile chronic arthritis.

Pathology The primary lesion is an in?ammation of the synovial membrane of joints. The synovial ?uid becomes diluted with in?ammatory exudate: if this persists for months it leads to progressive destruction of articular CARTILAGE and BONE. Cartilage is replaced by in?ammatory tissue known as pannus; a similar tissue invades bone to form erosions. Synovitis also affects tendon sheaths, and may lead to adhesion ?brosis or attrition and rupture of tendons. Subcutaneous and other bursae may be involved. Necrobiotic nodules also occur at sites outside synovium, including the subcutaneous tissues, the lungs, the pericardium and the pleura.

Clinical features Rheumatoid arthritis varies from the very mild to the severely disabling. Many mild cases probably go undiagnosed. At least 50 per cent of patients continue to lead a reasonably normal life; around 25 per cent are signi?cantly disabled in terms of work and leisure activities; and a minority become markedly disabled and are limited in their independence. There is often an early acute phase, followed by substantial remission, but in other patients gradual step-wise deterioration may occur, with progressive involvement of an increasing number of joints.

The diagnosis of rheumatoid arthritis is largely based on clinical symptoms and signs. Approximately 70 per cent of patients have rheumatoid factor ANTIBODIES in the SERUM but, because of the large number of false positives and false negatives, this test has very little value in clinical practice. It may be a useful pointer to a worse prognosis in early cases if the level is high. X-RAYS may help in diagnosing early cases and are particularly helpful when considering surgery or possible complications such as pathological fracture. Patients commonly develop ANAEMIA, which may be partly due to gastrointestinal blood loss from antiin?ammatory drug treatment (see below).

Treatment involves physical, pharmacological, and surgical measures, together with psychological and social support tailored to the individual patient’s needs. Regular activity should be maintained. Resting of certain joints such as the wrist with splints may be helpful at night or to assist prolonged manual activities. Sound footwear is important. Early use of antirheumatic drugs reduces long-term disability. Drug treatment includes simple ANALGESICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and slow-acting drugs including GOLD SALTS (in the form of SODIUM AUROTHIOMALATE), PENICILLAMINE, SULFASALAZINE, METHOTREXATE and AZATHIOPRINE.

The non-steroidal agents are largely e?ective in reducing pain and early-morning sti?ness, and have no e?ect on the chronic in?ammatory process. It is important, especially in the elderly, to explain to patients the adverse effects of NSAIDs, the dosage of which can be cut by prescribing paracetamol at the same time. Combinations of anti-rheumatic drugs seem better than single agents. The slow-acting drugs take approximately three months to act but have a more global e?ect on chronic in?ammation, with a greater reduction in swelling and an associated fall in erythrocyte sedimentation rate (ESR) and rise in the level of HAEMOGLOBIN. Local CORTICOSTEROIDS are useful, given into individual joints. Systemic corticosteroids carry serious problems if continued long term, but may be useful under special circumstances. Much research is currently going on into the use of tumour necrosis factor antagonists such as INFLIXIMAB and etanercept, but their precise role remains uncertain.

Health Source: Medical Dictionary
Author: Health Dictionary

the second most common form of *arthritis (after *osteoarthritis). It typically involves the joints of the fingers, wrists, feet, and ankles, with later involvement of the hips, knees, shoulders, and neck. It is a disease of the synovial lining of joints; the joints are initially painful, swollen, and stiff and are usually affected symmetrically. As the disease progresses the ligaments supporting the joints are damaged and there is erosion of the bone, leading to deformity of the joints. Tendon sheaths can be affected, leading to tendon rupture. Onset can be at any age, and there is a considerable range of severity. Women are at greater risk. Rheumatoid arthritis is an *autoimmune disease, and most patients show the presence of rheumatoid factor or other antibodies in their serum. There are characteristic changes on X-ray. In the early stages there is soft tissue swelling and periarticular osteoporosis; late stages are characterized by marginal bony erosions, narrowing of the articular space, articular destruction, and joint deformity.

Treatment is with a variety of drugs, including anti-inflammatory analgesics (see NSAID), corticosteroids, *disease-modifying antirheumatic drugs, and *biological therapies. Surgical treatment is by excision of the synovium in early cases or by *fusion or joint replacement once bony changes have occurred. (See also hip replacement.) The condition may resolve spontaneously, but is usually relapsing and remitting with steady progression. It may finally burn itself out, leaving severely deformed joints.

Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Arthritis

Inflammation of a joint... arthritis

Rheumatoid arthritis Health Dictionary

Rheumatoid Arthritis: From 3 Different Sources

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