How to Make Diagnosis of Rheumatoid Arthritis?

by admin on September 27, 2010

Rheumatoid arthritis is inflammation of joints which is chronic and non suppurative, its diagnosis is made on the basis of criteria given by Rheumatoid Association of America. Which says 3 or more features are there out of following list we can easily make the diagnosis of RA

1. Symmetrical involvement of joints

2. 3 or more joints are showing swelling

3. Patient giving history of morning stiffness of joints

4. Positive Rheumatoid factor

5. Rheumatoid nodules are present on body.

6. Swelling of joints in wrist and hands

7. If you see x-ray changes

This disease is common among age group of 30-50 years and women are 3 times more suffers of this disease.

Most common joints which are involved are MP & PIP i.e metacarpophalangeal joints & proximal interphalangeal joint, along with this wrists, knees, elbow and ankles are also involved.

On examination you will see swan neck deformity, boutonnier deformity of fingers, fingers and even is drifted towards ulna side, you can see the photograph below showing ulnar drift of thumb, and at the MP joint of thumb you can see a boggy swelling, which occurs due to synovial hypertrophy and intra articular effusion.

click on picture to see enlarged view

Elbow and knee will show flexion deformity, i.e you will not be able to perform extension, range of motion will be decreased, on ankle equines deformity is see while on foot hammer toe and hallux valgus is indexed see the picture below showing hallux valgus and normal big toe.

hallux valgus of great toe in rheumatoid arthritis

click on picture to see enlarged view

The basic reason of happening of this disease rheumatoid arthritis is the genetic predisposition, such patient must have obtained infection of  mycoplasma, or clostridium or Ebestein barr virus. Since patient is genetically predisposed so antibodies (IgM) are synthesized in body which deposits over synovial membrane. Synovium become oedematous and starts secreting more of synovial fluid, that why in examining the synovial fluid you get more than 3.5ml of fluid in RA. After that fibrinogen starts forming inside and hypertrophy of synovial membrane takes place. This hypertrophies synovium surrounds the outer area of articular cartilage and form PANNUS. With advancement of disease cartilage is worned off so as to expose the bone. In some of cases ankylosis develop, ankylosis means fusion which takes place due to pannus, in pannus fibrosis takes place leading to fibrous ankylosis, on this fibrous when calcification occurs leading to formation of bony ankylosis. Due to excessive swelling and fluid overload the joint size increases which causes stretch on ligaments of joints, this stretching leads to subluxation of joint.Patients of rheumatoid arthritis may give you history of fever, weight loss, fatigue, and rashes on face and extremities, but these rashes are non itchy.

what actually rheumatoid arthritis do watch out in animation form on video below on youtube by answerstv.com

Rheumatoid Arthritis stages: It is of 3 type, 1. potentially reversible soft tissue proliferation, 2. controllable but irreversible soft tissue destruction, here you will see a reduction in joint space on x-rays. 3. irreversible soft tissue & bony changes, the stage where ankylosis develops.

Differential Diagnosis of Rheumatoid Arthritis:

Osteo Arthritis: many of medical students gets confused over them, very important thing is age of onset, osteo arthritis seen in old age, distal inter phalangeal joint DIP is involved here, and patient will not give history of fever, weight loss and rashes.

Arthropathy in Psoriasis: here you will see typical psoriasis lesions over skin checked by auspitz sign & pits over nails.

Systemic lupus erythematosus: right here joint are involved but there is asymmetric involvement and you will see antinuclear antibody.

Treatment: Treatment involves giving NSAIDS, DMARDS and steroids, physiotherapy, heat therapy.

Surgical treatment includes

Synovectomy: its purpose is to prevent damage of joint by inflammation so main thing synovium where inflammation occurs is surgically removed from most common sites of RA.

Palliative surgery: when patient does not allow for synovectomy we do bone block operation and tendon lengthening.

Reconstructive Surgery: here we do joint replacement and tendon transfer.

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