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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Rheumatoid Arthritis (C0003873)

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, ゼ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