Rheumatoid Arthritis (RA)

Etiology

  • Autoimmune disorder affecting joints primarily, though can have systemic impact (i.e. kidneys, heart, lungs, skin, vascular system, GI, eyes, neurologic)

Risk Factors

  • Women > Men
  • Age 30-55
  • + family history

Symptoms

  • Fatigue
  • Subacute (>6w), persistent/progressive joint pain, stiffness, swelling
  • Often worse in AM (x ~1h) due to gelling → improves w/use
  • Tendency for polyarticular, bilateral involvement, commonly small and medium sized joints (hands, feet, ankles); sometimes atypical involvement, affecting knees/other large joints
  • At onset, symptoms can be vague and involve one or few joints
  • Nerve symptoms can be motor, sensory or from compression
  • SOB/DOE related to interstitial lung disease, nodules, pleural disease, pulmonary hypertension, or pericardial disease

Physical Exam Findings

  • Joint warmth, redness, spongy feeling from joint capsule inflammation (i.e. synovitis)
  • Pain w/squeezing of joints (hands)
  • Joint effusion sometimes
  • Joint deformity if longstanding, in particular MCPs, fingers (e.g. ulnar deviation, swan neck or boutonnierre deformities)
  • Extra articular findings: episcleritis, pleural/pericardial inflammation, rheumatoid nodules
  • Peripheral neuropathy related: decreased distal sensation, weakness, diminished reflexes

Tests

Links