II. Signs: General Joint Changes

  1. Joints affected have high synovium to cartilage ratio
  2. Synovium is initial site for joint destruction
    1. Pannus formation (Synovial Proliferation)
    2. Pannus grows to engulf the surrounding tissues
  3. Soft Tissue Destruction
    1. Results in laxity of tendons and ligaments
  4. Juxtaarticular bone erosion is ultimate RA course
  5. Inflammation of affected joints
    1. Boggy, tender, and warm
    2. Joints arenot erythematous
    3. Joints held in flexion to decrease pain
    4. Weakness at affected joints out of proportion to pain

III. Signs: Spared joints

  1. Thoracic and Lumbar Spine
  2. Sacroiliac joints
  3. Finger DIP joints
  4. Toe IP joints

IV. Signs: Hand Involvement

  1. Wrists are almost always affected
  2. Proximal Interphalangeal Joint (PIP) swelling
    1. Fusiform or spindle-shaped appearance of fingers
  3. Swan Neck deformity
    1. PIP hyperextension
    2. DIP flexion
  4. Metacarpophalangeal joint (MCP) swelling
  5. Sparing of Distal Interphalangeal Joint (DIP) joint
  6. Ulnar deviation of fingers
    1. Predisposes to palmar subluxation proximal phalanges
  7. Loss of hand strength
  8. Loss of pinch strength

V. Signs: Wrist Involvement

  1. Painless ulnar swelling in styloid area (Early change)
  2. Reduced range of motion
    1. Normal ROM: 180 degrees palmar to dorsiflexion
  3. Erosion of Pisiform and Triquetrum
  4. Median Nerve compression at volar wrist
    1. Carpal Tunnel Syndrome results

VI. Signs: Elbow Involvement

  1. Flexion contractures and swelling at elbow
  2. Para-Olecranon groove bony destruction
  3. Predisposition to Elbow Dislocation

VII. Signs: Shoulder Involvement

  1. Limited Range of Motion
  2. Tenderness below and lateral to coracoid process
  3. Rupture of joint capsule and subluxation of Humerus

VIII. Signs: Neck Involvement

  1. Predisposition to atlantoaxial subluxation
    1. Spinal Cord Compression
    2. Vertebrobasilar Insufficiency
      1. Syncope on downward gaze
  2. Limited Range of Motion
    1. Rotary ROM more affected than flexion and extension
  3. Occipital Headache

IX. Signs: Hip Involvement

  1. Abnormal Gait and limited joint motion
  2. Discomfort in the groin
    1. Pain may be referred to buttock or back

X. Signs: Knee Involvement

  1. Synovial hypertrophy and effusion

XI. Signs: Foot and Ankle Involvement

  1. Cocking up of toes
    1. Subluxation of Metatarsal heads
    2. Ultimately take on claw-like appearance
  2. Fibular deviation of 1st to 4th toes
  3. XRAY changes (may appear before hand and wrist)
    1. Fifth Metatarsal medial and lateral MTP
    2. Medial first to fourth MTP joints
    3. Great toe (first toe) ITP joint
  4. Retrocalcaneal Bursitis

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