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
XII. References
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| Definition (MEDLINEPLUS) |
Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in your joints. It can affect any joint but is common in the wrist and fingers. More women than men get rheumatoid arthritis. It often starts in middle age and is most common in older people. But children and young adults can also get it. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime. Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth and lungs. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body's own tissues. No one knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute. Treatments include medicine, lifestyle changes and surgery. These can slow or stop joint damage and reduce pain and swelling. NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases |
| Definition (NCI_NCI-GLOSS) | An autoimmune disease that causes pain, swelling, and stiffness in the joints, and may cause severe joint damage, loss of function, and disability. The disease may last from months to a lifetime, and symptoms may improve and worsen over time. |
| Definition (NCI) | A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated. |
| Definition (MSH) | A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated. |
| Definition (CSP) | chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures; etiology is unknown, but autoimmune mechanisms have been implicated. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D001172 |
| ICD9 | 714.0 |
| ICD10 | M06.9 , M06.99 |
| SnomedCT | 156471009, 287010008, 156481008, 69896004 |
| LNC | LP30644-6, LA15161-5 |
| English | Arthritis, Rheumatoid, ARTHRITIS RHEUMATOID, Rheumatoid Arthritis, Rheumatoid arthritis, unspecified, RHEUMATOID ARTHRITIS, RHEUMATOID ARTHRITIS, SUSCEPTIBILITY TO, Rheumatoid arthritis NOS, rheumatoid arthritis, RA (rheumatoid arthritis), rheumatoid arthritis (diagnosis), R arthritis, Rh arthritis, Arthritis rheumatoid, Systemic rheumatoid arthritis, RA, Arthritis, Rheumatoid [Disease/Finding], Rheumatoid arthritis, unspecified, site unspecified, rheumatoid arthritis systemic, gout rheumatic, proliferative arthritis, atrophic arthritis, Rheumatoid arthritis NOS (disorder), ARTHRITIS, RHEUMATOID, Rheumatoid arthritis, Atrophic arthritis, Chronic rheumatic arthritis, Rheumatic gout, RA - Rheumatoid arthritis, RhA - Rheumatoid arthritis, Rheumatoid disease, Rheumatoid arthritis (disorder), atrophic; arthritis, rheumatoid; arthritis, arthritis; atrophic, arthritis; rheumatoid, Atrophic Arthritis, Arthritis or polyarthritis, atrophic, Arthritis or polyarthritis, rheumatic |
| Portuguese | ARTRITE REUMATOIDE, Artrite reactiva reumatóide, Artrite atrófica, Artrite reumatóide sistémica, Artrite Reumatoide, Artrite reumatóide |
| Spanish | ARTRITIS REUMATOIDE, Artritis reumatoide sistémica, Artritis R, Artritis Re, Artritis atrófica, AR, Artritis Reumatoidea, artritis reumatoide, SAI, Rheumatoid arthritis NOS, artritis reumatoide, SAI (trastorno), artritis atrófica, artritis reumatoide (trastorno), artritis reumatoide, artritis reumática crónica, gota reumática, Artritis reumatoide, Artritis Reumatoide |
| Dutch | systemische reumatoïde artritis, atrofische artritis, RA, reumatische artritis, artritis; atrofisch, artritis; reumatoïd, atrofisch; artritis, reumatoïd; artritis, Reumatoïde artritis, niet gespecificeerd, reumatoïde artritis, Artritis, reumatoïde, Reumatoïde artritis |
| French | Arthrite d, Arthrite rhumatoïde systémique, AR, Polyarthrite rh, ARTHRITE RHUMATOIDE, Polyarthrite rhumatismale, PCE (Polyarthrite Chronique Évolutive), Polyarthrite chronique évolutive, Polyarthrite rhumatoïde, PR (Polyarthrite Rhumatoïde) |
| German | systemische rheumatische Arthritis, atrophische Arthritis, Rh Arthritis, RA, R Arthritis, ARTHRITIS RHEUMATOID, Chronische Polyarthritis, nicht naeher bezeichnet, rheumatoide Arthritis, Arthritis, rheumatoide, Rheumatoide Arthritis, PcP (Primär-chronische Polyarthritis), Polyarthritis, primär chronische, Primär-chronische Polyarthritis |
| Italian | Artrite reumatoide sistemica, AR, Artrite atrofica, Artrite reumatoide |
| Japanese | 全身性関節リウマチ, ｲｼｭｸｾｲｶﾝｾﾂｴﾝ, ｾﾞﾝｼﾝｾｲｶﾝｾﾂﾘｳﾏﾁ, ｶﾝｾﾂﾘｳﾏﾁ, 関節リウマチ, 萎縮性関節炎, リウマチ様関節炎, 慢性関節リウマチ, 関節リウマチ-慢性, 関節炎-リウマチ様 |
| Swedish | Ledgångsreumatism |
| Czech | polyartritida progresivní, Systémová revmatoidní artritida, Revmatoidní artritida, Atrofická artritida, artritida revmatoidní, revmatoidní artritida |
| Finnish | Nivelreuma |
| Russian | ARTRIT REVMATOIDNYI, ARTRIT INFEKTSIONNYI NESPETSIFICHESKII, POLIARTRIT REVMATOIDNYI, АРТРИТ ИНФЕКЦИОННЫЙ НЕСПЕЦИФИЧЕСКИЙ, АРТРИТ РЕВМАТОИДНЫЙ, ПОЛИАРТРИТ РЕВМАТОИДНЫЙ |
| Korean | 상세불명의 류마티스 관절염 |
| Croatian | ARTRITIS, REUMATOIDNI |
| Polish | Zapalenie stawów reumatoidalne, Gościec przewlekły postępujący, RZS, Reumatoidalne zapalenie stawów, Gościec pierwotnie przewlekły, Zapalenie gośćcowe |
| Hungarian | RA (rheumatoid arthritis), Rheumatoid arthritis, Atrophiás arthritis, R arthritis, Rh arthritis, Systemás rheumatoid arthritis |
| Norwegian | Artritt, revmatoid, Leddgikt, Revmatoid artritt |
