Rheumatoid arthritis

Definition: Inflammatory, seropositive, autoimmune joint disease.

 Causes: Chronic joint inflammation due to autoimmune cell activation and formation of immune complexes in joints. Joint destruction is gradual due to chronic inflammation and swelling.

Examination: Disease progression can be insidious at first, beginning with non-specific joint tenderness and stiffness due to inflammation; especially morning stiffness/pain lasting over an hour, with pain increasing again towards evening. Examine individual joints; look, feel, move. Joints typically affected are: proximal interphalangeals (PIPs) and metacarpophalangeals (MCPs), wrists, shoulders, elbows, knees and ankles. Symmetrical polyarthritis and joint deformity is characteristic of RA. Range of movement is decreased. Wrists are typically swollen with ulnar deviation of fingers and muscular wasting. There can be hyperflexion or hyperextension of PIPs and MCPs (‘Swan neck’ and Boutonniere deformity). RA has many extra-articular (anaemia, episcleritis/scleritis, vasculitis, pleural effusion, etc.) and systemic (weight loss, pyrexia, tiredness, frequent infection) manifestations. Ask about skin and eye problems and infections.