II. Signs: General Joint Changes
- See Rheumatoid Arthritis Prediction Rule for Undifferentiated Arthritis
- Joints affected have high synovium to cartilage ratio
- Synovium is initial site for joint destruction
- Pannus formation (Synovial Proliferation)
- Pannus grows to engulf the surrounding tissues
- Soft Tissue Destruction
- Results in laxity of tendons and ligaments
- Juxtaarticular bone erosion is ultimate RA course
- Inflammation of affected joints
- Boggy, tender, and warm
- Joints arenot erythematous
- Joints held in flexion to decrease pain
- Weakness at affected joints out of proportion to pain
III. Signs: Spared joints
- Thoracic and Lumbar Spine
- Sacroiliac joints
- Finger DIP joints
- Toe IP joints
IV. Signs: Hand Involvement
- Wrists are almost always affected
- Proximal Interphalangeal Joint (PIP) swelling
- Fusiform or spindle-shaped appearance of fingers
- Swan Neck deformity
- PIP hyperextension
- DIP flexion
- Metacarpophalangeal joint (MCP) swelling
- Sparing of Distal Interphalangeal Joint (DIP) joint
- Ulnar deviation of fingers
- Predisposes to palmar subluxation proximal phalanges
- Loss of hand strength
- Loss of pinch strength
V. Signs: Wrist Involvement
- Painless ulnar swelling in styloid area (Early change)
- Reduced range of motion
- Normal ROM: 180 degrees palmar to dorsiflexion
- Erosion of Pisiform and Triquetrum
-
Median Nerve compression at volar wrist
- Carpal Tunnel Syndrome results
VI. Signs: Elbow Involvement
- Flexion contractures and swelling at elbow
- Para-Olecranon groove bony destruction
- Predisposition to Elbow Dislocation
VII. Signs: Shoulder Involvement
- Limited Range of Motion
- Tenderness below and lateral to coracoid process
- Rupture of joint capsule and subluxation of Humerus
VIII. Signs: Neck Involvement
- Predisposition to atlantoaxial subluxation
- Spinal Cord Compression
- Vertebrobasilar Insufficiency
- Syncope on downward gaze
- Limited Range of Motion
- Rotary ROM more affected than flexion and extension
- Occipital Headache
IX. Signs: Hip Involvement
- Abnormal Gait and limited joint motion
- Discomfort in the groin
- Pain may be referred to buttock or back
X. Signs: Knee Involvement
- Synovial hypertrophy and effusion
XI. Signs: Foot and Ankle Involvement
- Cocking up of toes
- Subluxation of Metatarsal heads
- Ultimately take on claw-like appearance
- Fibular deviation of 1st to 4th toes
- XRAY changes (may appear before hand and wrist)
- Fifth Metatarsal medial and lateral MTP
- Medial first to fourth MTP joints
- Great toe (first toe) ITP joint
- Retrocalcaneal Bursitis